Provider Demographics
NPI:1003897372
Name:CREST RADIOLOGICAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:CREST RADIOLOGICAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FRIESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-776-5325
Mailing Address - Street 1:421 W CHEW ST
Mailing Address - Street 2:PHYSICIAN ACCOUNTS
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3406
Mailing Address - Country:US
Mailing Address - Phone:610-776-5100
Mailing Address - Fax:610-663-3113
Practice Address - Street 1:421 W CHEW ST
Practice Address - Street 2:DEPARTMENT OF DIAGNOSTIC RADIOLOGY
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3406
Practice Address - Country:US
Practice Address - Phone:610-776-4822
Practice Address - Fax:610-776-4671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0040604000OtherIBC
46716OtherAMERIHEALTH MERCY
1519574OtherGATEWAY HEALTH PLAN
PA0006736180002Medicaid
02410000OtherCBC
068337OtherHIGHMARK BLUE SHIELD GROU
CI1114OtherRR MEDICARE GROUP #
068337OtherHIGHMARK BLUE SHIELD GROU