Provider Demographics
NPI:1003949603
Name:CAPITAL HEALTH PARTNERS, LLC
Entity Type:Organization
Organization Name:CAPITAL HEALTH PARTNERS, LLC
Other - Org Name:ADVANCED IMAGING SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:M
Authorized Official - Last Name:BODNAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-504-2519
Mailing Address - Street 1:1000 MEADE ST MEDICAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18509
Mailing Address - Country:US
Mailing Address - Phone:570-504-2519
Mailing Address - Fax:570-504-2599
Practice Address - Street 1:1000 MEADE ST
Practice Address - Street 2:MEDICAL PLAZA
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-3195
Practice Address - Country:US
Practice Address - Phone:570-504-2519
Practice Address - Fax:570-504-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207U00000X, 207UN0902X, 2085B0100X, 2085N0700X, 2085P0229X, 2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Not Answered207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & TherapyGroup - Single Specialty
Not Answered2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Not Answered2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
Not Answered2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Single Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019606390001Medicaid
PAB41526Medicare UPIN
PA071399Medicare PIN
PA0019606390001Medicaid
PAI37902Medicare UPIN
PAC26524Medicare UPIN
PAG30493Medicare UPIN
PAE21901Medicare UPIN
PAG19639Medicare UPIN