1598789000 NPI number — NORTHEASTERN PENNSYLVANIA IMAGING CENTER

Table of content: (NPI 1598789000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598789000 NPI number — NORTHEASTERN PENNSYLVANIA IMAGING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEASTERN PENNSYLVANIA IMAGING CENTER
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:
1598789000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2601 STAFFORD AVE
Provider Second Line Business Mailing Address:
PO BOX 3305
Provider Business Mailing Address City Name:
SCRANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18505-0305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-346-6633
Provider Business Mailing Address Fax Number:
570-346-4049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 STAFFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18505-0305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-346-6633
Provider Business Practice Location Address Fax Number:
570-346-4049
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
JULIANN
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
570-346-6633

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0904X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085P0229X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000072505 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0032528 . This is a "AETNA PIN NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1686 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20010377 . This is a "20010377" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011162430005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB3186 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 053243 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2Y6956 . This is a "PHS HEALTHNET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 475385 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 999004 . This is a "BLUE CROSS NE PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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