1477595023 NPI number — EASTON RADIOLOGY ASSOCIATES, P.C.

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 1477595023 NPI number — EASTON RADIOLOGY ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTON RADIOLOGY ASSOCIATES, P.C.
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:
EASTON RADIOLOGY DIAGNOSTIC IMAGING CENTER
Provider Other Organization Name Type Code:
3
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:
1477595023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 468
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERWICK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18603-0468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-274-7676
Provider Business Mailing Address Fax Number:
484-446-8012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 FERRY STREET
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:
18042-3815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-923-7884
Provider Business Practice Location Address Fax Number:
610-923-6340
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
610-258-4055

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0008657240013 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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