1417907023 NPI number — VALLEY ADVANCED IMAGING LLC

Table of content: (NPI 1417907023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417907023 NPI number — VALLEY ADVANCED IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY ADVANCED IMAGING LLC
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:
1417907023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2403 BUTLER STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-258-1200
Provider Business Mailing Address Fax Number:
610-258-1106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2403 BUTLER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-258-1200
Provider Business Practice Location Address Fax Number:
610-258-1106
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STUPPINO
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO OWNER
Authorized Official Telephone Number:
610-865-4738

Provider Taxonomy Codes

  • Taxonomy code: 2471N0900X , with the licence number:  3054015 , 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: 01887332 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2035663000 . This is a "INDEPENDENCE BLUE CROSS H" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2572590 . This is a "AETNA US HEALTHCARE HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00110029 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: VA1339666 . This is a "PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 118732 . This is a "THREE RIVERS HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001339666 . This is a "INDEPENDENCE BLUE CROSS P" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002104142 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02986400 . This is a "CAPITAL ADVANTAGE INSURAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7633253 . This is a "AETNA US HEALTHCARE TRADI" identifier . This identifiers is of the category "OTHER".




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