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Organization

DWAYNE R COOK HERITAGE MOBILE X-RAY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DWAYNE ROBERT COOK I RT (OWNER)
(757) 580-6040
Entity
Organization

Contact information

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

Taxonomy

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

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
008946752
VA
Enumeration date
04/17/2008
Last updated
05/31/2011
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