1366699829 NPI number — DIAGNOSTIC IMAGING CENTERS OF NEPA, LLC

Table of content: (NPI 1366699829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366699829 NPI number — DIAGNOSTIC IMAGING CENTERS OF NEPA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTIC IMAGING CENTERS OF NEPA, 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:
6
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:
1366699829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 MEADE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNMORE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18512-3195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-504-2519
Provider Business Mailing Address Fax Number:
570-504-2599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 N ABINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKS GREEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18411-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-504-2519
Provider Business Practice Location Address Fax Number:
570-504-2599
Provider Enumeration Date:
08/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BODNAR
Authorized Official First Name:
LORI
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
570-504-2500

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)





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