1659488161 NPI number — JENNERSVILLE OPEN MRI AND IMAGING CENTER, LLC

Table of content: MRS. CHRISTINE MARY LECUYER R.N. (NPI 1962697888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659488161 NPI number — JENNERSVILLE OPEN MRI AND IMAGING CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENNERSVILLE OPEN MRI AND IMAGING CENTER, 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:
1659488161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 W BALTIMORE PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST GROVE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19390-9313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-869-8889
Provider Business Mailing Address Fax Number:
610-869-7688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 W BALTIMORE PIKE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WEST GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-869-8889
Provider Business Practice Location Address Fax Number:
610-869-7688
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROLLINS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
610-869-8889

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  3688169 , 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: 1019122220001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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