Provider Demographics
NPI:1093736142
Name:ALLEGHENY IMAGING INSTITUTE, INC
Entity Type:Organization
Organization Name:ALLEGHENY IMAGING INSTITUTE, INC
Other - Org Name:KENNEDY MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:BEISLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-929-1336
Mailing Address - Street 1:P.O. BOX 952468
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-2468
Mailing Address - Country:US
Mailing Address - Phone:407-929-1336
Mailing Address - Fax:407-333-2505
Practice Address - Street 1:1800 PINE HOLLOW RD
Practice Address - Street 2:KENNEDY MEDICAL ARTS BUILDING
Practice Address - City:KENNEDY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15136
Practice Address - Country:US
Practice Address - Phone:412-331-3477
Practice Address - Fax:412-331-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA698183OtherBLUE SHIELD
698183OtherHIGHMARK BCBS
PA001842760000002Medicaid
PA184276000002Medicaid
PA698183OtherBLUE SHIELD