Organization
BROAD 64 IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY RALSTON (SYSTEM DIRECTOR)
(419) 996-5119
Entity
Organization
Contact information
Practice address
6605 W BROAD ST, SUITE B - GROUND FLOOR, RICHMOND, VA 23230
(804) 281-0215
Mailing address
PO BOX 631146, CINCINNATI, OH 45263-1146
(513) 952-5002
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
12/01/2006
Last updated
11/04/2020
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