Provider Demographics
NPI:1164756300
Name:KEYSTONE DIAGNOSTICS AND MRI, LLC
Entity Type:Organization
Organization Name:KEYSTONE DIAGNOSTICS AND MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINCOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-893-4700
Mailing Address - Street 1:7622 OGONTZ AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1817
Mailing Address - Country:US
Mailing Address - Phone:215-224-8980
Mailing Address - Fax:215-893-4704
Practice Address - Street 1:7625 OGONTZ AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1816
Practice Address - Country:US
Practice Address - Phone:215-224-9515
Practice Address - Fax:215-224-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA166547Medicare PIN