1922182690 NPI number — ROCHESTER MOBILE X-RAY, INC.

Table of content: (NPI 1922182690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922182690 NPI number — ROCHESTER MOBILE X-RAY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCHESTER MOBILE X-RAY, 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:
1922182690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1769 W 26TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16508-1256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-459-6280
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 BUELL ROAD
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14624-3134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-836-9729
Provider Business Practice Location Address Fax Number:
585-436-5340
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WUERSTLE
Authorized Official First Name:
JACOB
Authorized Official Middle Name:
RUSSELL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-459-6820

Provider Taxonomy Codes

  • Taxonomy code: 335V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01690720 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02998052 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02459630 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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