1295805547 NPI number — EASTERN PENNSYLVANIA IMAGING CONSULTANTS, PC

Table of content: EVA MARIE GOINS RN (NPI 1932614807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295805547 NPI number — EASTERN PENNSYLVANIA IMAGING CONSULTANTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN PENNSYLVANIA IMAGING CONSULTANTS, PC
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:
1295805547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2430 BUTLER STREET
Provider Second Line Business Mailing Address:
SUITE 114
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18042-5303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-250-4000
Provider Business Mailing Address Fax Number:
610-923-8160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 S 21ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18042-3851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-250-4592
Provider Business Practice Location Address Fax Number:
610-923-8160
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHUBACH
Authorized Official First Name:
GREGG
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
CHAIRMAN, RADIOLOGY DEPARTMENT
Authorized Official Telephone Number:
610-250-4000

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: 1018285300001 . This is a "MEDICAID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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