# BROAD 64 IMAGING LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316015985
- **Authorized official:** KIMBERLY RALSTON (SYSTEM DIRECTOR)
- **Authorized official phone:** (419) 996-5119

## Contact information

- **Practice address:** 6605 W BROAD ST, SUITE B - GROUND FLOOR, RICHMOND, VA 23230
- **Practice address phone:** (804) 281-0215
- **Mailing address:** PO BOX 631146, CINCINNATI, OH 45263-1146
- **Mailing address phone:** (513) 952-5002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/01/2006
- **Last updated:** 11/04/2020