Basic Information
| Provider Information | |||||||||
| NPI: | 1861595530 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL IMAGING P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1416 HOLTON AVE E | ||||||||
| Address2: | |||||||||
| City: | BIG STONE GAP | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242193340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2765237943 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 COMBS RD | ||||||||
| Address2: | |||||||||
| City: | PENNINGTON GAP | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242771808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2765237943 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SAHA | ||||||||
| AuthorizedOfficialFirstName: | SUBHASH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2765237943 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 0101028715 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 383597 | 05 | VA | MEDICAID |