1841254646 NPI number — JEFFERSON REGIONAL PET SCANNING GP

Table of content: (NPI 1841254646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841254646 NPI number — JEFFERSON REGIONAL PET SCANNING GP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON REGIONAL PET SCANNING GP
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:
1841254646
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:
1200 BROOKS LANE
Provider Second Line Business Mailing Address:
STE G50
Provider Business Mailing Address City Name:
CLAIRTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-469-8308
Provider Business Mailing Address Fax Number:
412-469-8309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 BROOKS LANE
Provider Second Line Business Practice Location Address:
STE G50
Provider Business Practice Location Address City Name:
CLAIRTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-469-8308
Provider Business Practice Location Address Fax Number:
412-469-8309
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAGAN
Authorized Official First Name:
AL
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
412-205-6095

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X , with the licence number:  PA0899 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 410453 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1387329 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 135445 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 800468 . This is a "FED BLACK LUNG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 188642 . This is a "HEALTH AMERICA ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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