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Organization
SHORT PUMP IMAGING LLC
Active
Organization
SHORT PUMP IMAGING LLC
Active
Other names
Independence Park Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVELLE R HARDIN (CREDENTIALING COORDINATOR)
(615) 344-8203
Entity
Organization
Contact information
Practice address
4200 GREYBULL DR STE 100, RICHMOND, VA 23233-7555
(804) 217-9729
Mailing address
2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4692
(615) 373-7406
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
NULL
261QR0200X
Radiology Clinic/Center
Primary
—
NULL
261QR0206X
Mammography Clinic/Center
—
NULL
Other
Enumeration date
05/28/2006
Last updated
02/26/2025
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