1619955374 NPI number — IMAGE RADIOLOGY GROUP

Table of content: (NPI 1619955374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619955374 NPI number — IMAGE RADIOLOGY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMAGE RADIOLOGY GROUP
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:
1619955374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 CHAMBER PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLEROI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15022-1620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-489-0263
Provider Business Mailing Address Fax Number:
724-489-0267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4198 WASHINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC MURRAY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15317-2560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-942-5144
Provider Business Practice Location Address Fax Number:
724-942-8141
Provider Enumeration Date:
01/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REBAR
Authorized Official First Name:
TONYA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
724-489-0263

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0508628 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1009731 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1537247 . This is a "UNITED MINE WORKERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012584360010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012584360015 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 710328 . This is a "BLUECROSS/BLUESHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012584360009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19136 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012584360014 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: C10824 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012584360013 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62457 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012584360011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012584360018 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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