1992945935 NPI number — DIAGNOSTIC IMAGING CENTERS OF NEPA, LLC

Table of content: CONCHOTA LOLETTE SINGLETON RN (NPI 1245874486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992945935 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:
1992945935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2009
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:
MEDICAL PLAZA
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:
111 HULST DR
Provider Second Line Business Practice Location Address:
STE 708
Provider Business Practice Location Address City Name:
MATAMORAS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18336-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-491-9200
Provider Business Practice Location Address Fax Number:
570-491-9201
Provider Enumeration Date:
03/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BODNAR
Authorized Official First Name:
LORI
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR OF BILLING/CONTRACTING
Authorized Official Telephone Number:
570-504-2519

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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