Organization
KANAWHA VALLEY RADIOLOGISTS INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL A RODGERS MD (AUTHORIZED OFFICIAL)
(304) 343-4625
Entity
Organization
Contact information
Practice address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 766-3600
(304) 343-4626
Mailing address
PO BOX 840, LIMA, OH 45802-0840
(877) 574-7116
(419) 223-2726
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008099000
—
WV
01
—
001709440
MT STATE BLUE CROSS GRP #
WV
05
—
0060705
—
OH
01
—
020021700
FEDERAL BLACK LUNG
WV
01
—
0216288
OHIO MEDICAID
OH
01
—
5643
CARELINK
WV
Enumeration date
09/22/2006
Last updated
04/22/2022
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