Provider Demographics
NPI:1346224912
Name:VALLEY ADVANCED MRI, LLC
Entity Type:Organization
Organization Name:VALLEY ADVANCED MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-634-2222
Mailing Address - Street 1:PO BOX 25092
Mailing Address - Street 2:
Mailing Address - City:LEHIGH VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18002-5092
Mailing Address - Country:US
Mailing Address - Phone:610-258-1200
Mailing Address - Fax:610-258-1106
Practice Address - Street 1:2403 BUTLER ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-5302
Practice Address - Country:US
Practice Address - Phone:610-258-1200
Practice Address - Fax:610-258-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA053223Medicare ID - Type Unspecified