1225129901 NPI number — RADIOLOGY & MRI OF BETHLEHEM, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225129901 NPI number — RADIOLOGY & MRI OF BETHLEHEM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY & MRI OF BETHLEHEM, 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:
1225129901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5325 NORTHGATE DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18017-9411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-691-8931
Provider Business Mailing Address Fax Number:
610-691-8947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5325 NORTHGATE DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18017-9411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-691-8931
Provider Business Practice Location Address Fax Number:
610-691-8947
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MACIEJCZYK
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
610-691-8931

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: 01128342 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC5242 . This is a "PALMETTO GBA-RAILROAD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 405224 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0054332 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02286700 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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