Provider Demographics
NPI:1417907023
Name:VALLEY ADVANCED IMAGING LLC
Entity Type:Organization
Organization Name:VALLEY ADVANCED IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:STUPPINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-865-4738
Mailing Address - Street 1:2403 BUTLER STREET
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042
Mailing Address - Country:US
Mailing Address - Phone:610-258-1200
Mailing Address - Fax:610-258-1106
Practice Address - Street 1:2403 BUTLER STREET
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
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:2006-05-12
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA30540152471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01887332Medicaid
2035663000OtherINDEPENDENCE BLUE CROSS H
2572590OtherAETNA US HEALTHCARE HMO
PAP00110029OtherRAILROAD MEDICARE
VA1339666OtherPA BLUE SHIELD
118732OtherTHREE RIVERS HEALTH PLANS
001339666OtherINDEPENDENCE BLUE CROSS P
002104142OtherUNITED HEALTHCARE
02986400OtherCAPITAL ADVANTAGE INSURAN
7633253OtherAETNA US HEALTHCARE TRADI
=========OtherFIRST HEALTH
02986400OtherCAPITAL ADVANTAGE INSURAN
PAP00110029OtherRAILROAD MEDICARE
PA01887332Medicaid
2035663000OtherINDEPENDENCE BLUE CROSS H
=========OtherTRICARE CHAMPUS
=========OtherTRICARE CHAMPUS