Provider Demographics
NPI:1043475551
Name:DIAGNOSTIC IMAGING CENTERS OF NEPA LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING CENTERS OF NEPA LLC
Other - Org Name:ADVANCED IMAGING SPECIALISTS (AIS)
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:RCC
Authorized Official - Phone:570-504-2519
Mailing Address - Street 1:1000 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-3195
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:
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:2008-07-23
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty