1528058245 NPI number — EXTREMITY IMAGING PARTNERS INC

Table of content: (NPI 1528058245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528058245 NPI number — EXTREMITY IMAGING PARTNERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXTREMITY IMAGING PARTNERS 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:
1528058245
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 BROOKTREE RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
WEXFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15090-9289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-398-7364
Provider Business Mailing Address Fax Number:
866-267-0144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 BROOKTREE RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
WEXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15090-9289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-398-7364
Provider Business Practice Location Address Fax Number:
866-267-0144
Provider Enumeration Date:
10/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DIGIACOBBE
Authorized Official First Name:
A JEROME
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
866-398-7364

Provider Taxonomy Codes

  • Taxonomy code: 2471M1202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200423690A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 258396 . This is a "HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA255 . This is a "ONE CALL MEDICAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000340701 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000378160 . This is a "ANTHEM BCBS-DAYTON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1009572010004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300686212 . This is a "W/C US DEPT OF LABOR OWPC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2273614 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1009572010002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7823651 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000340701 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1009572010001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1009572010003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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