Provider Demographics
NPI:1417903717
Name:JEANES RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:JEANES RADIOLOGY ASSOCIATES
Other - Org Name:PA OPEN MRI @ COUNTY LINE PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-379-8458
Mailing Address - Street 1:101 GREENWOOD AVE
Mailing Address - Street 2:SUITE 151
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2627
Mailing Address - Country:US
Mailing Address - Phone:215-379-8458
Mailing Address - Fax:215-379-8461
Practice Address - Street 1:15200 BUSTLETON AVE
Practice Address - Street 2:COUNTY LINE PLAZA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1120
Practice Address - Country:US
Practice Address - Phone:215-676-6500
Practice Address - Fax:215-676-9753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty