1134315369 NPI number — MONTGOMERY COUNTY ADVANCED MEDICAL IMAGING, LLC

Table of content: (NPI 1134315369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134315369 NPI number — MONTGOMERY COUNTY ADVANCED MEDICAL IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY COUNTY ADVANCED MEDICAL IMAGING, 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:
1134315369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 OREGON PIKE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17601-4890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-390-2479
Provider Business Mailing Address Fax Number:
770-776-5837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 BLAIR MILL RD
Provider Second Line Business Practice Location Address:
BLAIRWOOD BLDG. SUITE 9
Provider Business Practice Location Address City Name:
WILLOW GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19090-1041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-481-3377
Provider Business Practice Location Address Fax Number:
215-481-7682
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
O'MOORE
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
VINCENT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-481-2079

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  PA-0055 , 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)





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