1083698484 NPI number — TRI COUNTY IMAGING ASSOC. LTD

Table of content: (NPI 1083698484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083698484 NPI number — TRI COUNTY IMAGING ASSOC. LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI COUNTY IMAGING ASSOC. LTD
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:
1083698484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1198
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15501-0336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-444-1918
Provider Business Mailing Address Fax Number:
814-444-9782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10455 LINCOLN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15537-7046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-444-1918
Provider Business Practice Location Address Fax Number:
814-444-9782
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WATTS
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
814-444-1918

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0011325600010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 526016 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 106739 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1509635 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000063834 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 699866600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0113399000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com