1003897372 NPI number — CREST RADIOLOGICAL ASSOCIATES INC.

Table of content: (NPI 1003897372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003897372 NPI number — CREST RADIOLOGICAL ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREST RADIOLOGICAL ASSOCIATES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003897372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 W CHEW ST
Provider Second Line Business Mailing Address:
PHYSICIAN ACCOUNTS
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18102-3406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-776-5100
Provider Business Mailing Address Fax Number:
610-663-3113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 W CHEW ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF DIAGNOSTIC RADIOLOGY
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18102-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-776-4822
Provider Business Practice Location Address Fax Number:
610-776-4671
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FRIESS
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-776-5325

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0040604000 . This is a "IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 46716 . This is a "AMERIHEALTH MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1519574 . This is a "GATEWAY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0006736180002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02410000 . This is a "CBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 068337 . This is a "HIGHMARK BLUE SHIELD GROU" identifier . This identifiers is of the category "OTHER".
  • Identifier: CI1114 . This is a "RR MEDICARE GROUP #" identifier . This identifiers is of the category "OTHER".




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