Provider Demographics
NPI:1083877476
Name:PHOENIX DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:PHOENIX DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:RACIOPPI
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:610-948-1487
Mailing Address - Street 1:368 N LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1576
Mailing Address - Country:US
Mailing Address - Phone:610-948-1487
Mailing Address - Fax:610-948-1499
Practice Address - Street 1:368 N LEWIS RD
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-1576
Practice Address - Country:US
Practice Address - Phone:610-948-1487
Practice Address - Fax:610-948-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty