Provider Demographics
NPI:1275620437
Name:PROFESSIONAL RADIOLOGY CONSULTANTS, PC
Entity Type:Organization
Organization Name:PROFESSIONAL RADIOLOGY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-725-9800
Mailing Address - Street 1:11487 SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-3143
Mailing Address - Country:US
Mailing Address - Phone:814-725-9800
Mailing Address - Fax:814-725-9800
Practice Address - Street 1:612 W SMITH ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1152
Practice Address - Country:US
Practice Address - Phone:814-664-4641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031177E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1916238Medicaid
PAPR1332073OtherBLUESHIELD
PA056591Medicare ID - Type Unspecified