Provider Demographics
NPI:1083765739
Name:PHYSICIANCARE PC
Entity Type:Organization
Organization Name:PHYSICIANCARE PC
Other - Org Name:PHYSICIANCARE IMAGING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-265-6300
Mailing Address - Street 1:71 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-9702
Mailing Address - Country:US
Mailing Address - Phone:570-265-6300
Mailing Address - Fax:570-268-2807
Practice Address - Street 1:71 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-9702
Practice Address - Country:US
Practice Address - Phone:570-265-6300
Practice Address - Fax:570-268-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty