1528069556 NPI number — WARREN RADIOLOGY ASSOCIATES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528069556 NPI number — WARREN RADIOLOGY ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WARREN RADIOLOGY 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:
1528069556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 456
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16365-0456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-723-1689
Provider Business Mailing Address Fax Number:
814-723-9276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2-12 CRESCENT PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16365-2221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-723-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KUHNEN
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
H
Authorized Official Title or Position:
TREASURER WRA
Authorized Official Telephone Number:
814-723-3300

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0722605 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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