Provider Demographics
NPI:1083698484
Name:TRI COUNTY IMAGING ASSOC. LTD
Entity Type:Organization
Organization Name:TRI COUNTY IMAGING ASSOC. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-444-1918
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-0336
Mailing Address - Country:US
Mailing Address - Phone:814-444-1918
Mailing Address - Fax:814-444-9782
Practice Address - Street 1:10455 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7046
Practice Address - Country:US
Practice Address - Phone:814-444-1918
Practice Address - Fax:814-444-9782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011325600010Medicaid
PA526016OtherHIGHMARK BLUE SHIELD
PA106739OtherUPMC
PA1509635Medicaid
PA000000063834Medicaid
MD699866600Medicaid
PA0113399000OtherPERSONAL CHOICE
PA000000063834Medicaid
PA526016OtherHIGHMARK BLUE SHIELD