Provider Demographics
NPI:1871774703
Name:IMAGING INTERNATIONAL PC
Entity type:Organization
Organization Name:IMAGING INTERNATIONAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:L
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:276-739-7989
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-0208
Mailing Address - Country:US
Mailing Address - Phone:276-623-8100
Mailing Address - Fax:
Practice Address - Street 1:315 FALLS DR NW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-8093
Practice Address - Country:US
Practice Address - Phone:276-623-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010232082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA245419OtherANTHEM
VAA99914Medicare UPIN
VAC08439Medicare PIN