Provider Demographics
NPI:1679572333
Name:OPEN MRI OF SOUTHERN VA
Entity type:Organization
Organization Name:OPEN MRI OF SOUTHERN VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-915-4602
Mailing Address - Street 1:PO BOX 35695
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-0695
Mailing Address - Country:US
Mailing Address - Phone:804-327-9242
Mailing Address - Fax:904-327-9812
Practice Address - Street 1:1509 WEST THIRD STREET
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2649
Practice Address - Country:US
Practice Address - Phone:434-315-0306
Practice Address - Fax:434-315-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004991460Medicaid
VAC08530Medicare PIN
VA004991460Medicaid