1073575890 NPI number — RAYSTOWN IMAGING, INC

Table of content: (NPI 1073575890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073575890 NPI number — RAYSTOWN IMAGING, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAYSTOWN IMAGING, 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:
1073575890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 BRYAN ST
Provider Second Line Business Mailing Address:
PO BOX 382, SUITE 2
Provider Business Mailing Address City Name:
HUNTINGDON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16652-2413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-643-6207
Provider Business Mailing Address Fax Number:
814-643-6165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 WARM SPRINGS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16652-2350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-643-6207
Provider Business Practice Location Address Fax Number:
814-643-6165
Provider Enumeration Date:
04/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PETTINGER
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-643-6207

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  118042 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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