# DWAYNE R COOK HERITAGE MOBILE X-RAY

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

## Provider details

- **NPI number:** 1588838817
- **Authorized official:** MR. DWAYNE ROBERT COOK I RT (OWNER)
- **Authorized official phone:** (757) 580-6040

## Contact information

- **Practice address:** 6330 N CENTER DR, SUITE 107, NORFOLK, VA 23502-4008
- **Practice address phone:** (757) 466-1163
- **Practice address fax:** (757) 466-1178
- **Mailing address:** PO BOX 2145, CHESAPEAKE, VA 23327-2145
- **Mailing address phone:** (757) 466-1163
- **Mailing address fax:** (757) 466-1178

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 0120 002367 | VA | Yes |

## Other

- **Enumeration date:** 04/17/2008
- **Last updated:** 05/31/2011