Provider Demographics
NPI:1134315369
Name:MONTGOMERY COUNTY ADVANCED MEDICAL IMAGING, LLC
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY ADVANCED MEDICAL IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:O'MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-481-2079
Mailing Address - Street 1:2501 OREGON PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4890
Mailing Address - Country:US
Mailing Address - Phone:717-390-2479
Mailing Address - Fax:770-776-5837
Practice Address - Street 1:2701 BLAIR MILL RD
Practice Address - Street 2:BLAIRWOOD BLDG. SUITE 9
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1041
Practice Address - Country:US
Practice Address - Phone:215-481-3377
Practice Address - Fax:215-481-7682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA-0055261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA119606Medicare PIN