1316083595 NPI number — PHYSICIAN'S MOBILE X-RAY, INC.

Table of content: (NPI 1316083595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316083595 NPI number — PHYSICIAN'S MOBILE X-RAY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIAN'S MOBILE X-RAY, 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:
1316083595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6310 ALLENTOWN BLVD STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17112-2739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-561-4940
Provider Business Mailing Address Fax Number:
717-561-4999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
945 E PARK DR
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17111-2804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-561-4940
Provider Business Practice Location Address Fax Number:
717-561-4999
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GELBAUGH
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
717-561-4940

Provider Taxonomy Codes

  • Taxonomy code: 335V00000X , 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)

  • Identifier: 1507996 . This is a "GATEWAY PA MEDICAID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 335685 . This is a "ADVANTRA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000094397 . This is a "UNISON HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000399807 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1507996 . This is a "GATEWAY MEDICARE ASSURED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 441630015 . This is a "UNITED HEALTHCARE RR MC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000138896 . This is a "APWU" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000859039 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25-1352947 . This is a "CONTINENTAL GENERAL INS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 25-1352947 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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