Provider Demographics
NPI:1245231240
Name:HEALTH BRIDGE IMAGING LLC
Entity Type:Organization
Organization Name:HEALTH BRIDGE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YALE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-422-0405
Mailing Address - Street 1:809 FARSON STREET
Mailing Address - Street 2:UNIT 107
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-1066
Mailing Address - Country:US
Mailing Address - Phone:304-422-0405
Mailing Address - Fax:304-485-4466
Practice Address - Street 1:809 FARSON STREET
Practice Address - Street 2:UNIT 107
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1066
Practice Address - Country:US
Practice Address - Phone:304-422-0405
Practice Address - Fax:304-485-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6802006000Medicaid
OH2402877OtherMEDICAID
WV6802006000Medicaid