1811968324 NPI number — SHENANGO VALLEY IMAGING ASSOCIATES LLC

Table of content: (NPI 1811968324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811968324 NPI number — SHENANGO VALLEY IMAGING ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHENANGO VALLEY IMAGING ASSOCIATES 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:
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:
1811968324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW STANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15672-0450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-925-2330
Provider Business Mailing Address Fax Number:
724-925-7816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 N HERMITAGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16148-3278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-342-2554
Provider Business Practice Location Address Fax Number:
724-342-2555
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELLER
Authorized Official First Name:
JACE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
724-925-2280

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  N/A ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1013686280001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1753311 . This is a "HIGHMARK BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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