1144311473 NPI number — KINETIC IMAGING, INC

Table of content: (NPI 1144311473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144311473 NPI number — KINETIC IMAGING, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINETIC IMAGING, 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:
1144311473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4520 UNION DEPOSIT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17111-2910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-652-6105
Provider Business Mailing Address Fax Number:
717-652-2465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 SPRINT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17013-7696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-960-3313
Provider Business Practice Location Address Fax Number:
717-690-3301
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LADD
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
RADIOLOGIST
Authorized Official Telephone Number:
717-960-3313

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  MD047428L , 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: 10170914600001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com