Provider Demographics
NPI:1457652687
Name:LACKAWANNA X-RAY, LLC
Entity Type:Organization
Organization Name:LACKAWANNA X-RAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOELKERS
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:570-346-8809
Mailing Address - Street 1:1229 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2807
Mailing Address - Country:US
Mailing Address - Phone:570-346-8809
Mailing Address - Fax:570-346-5121
Practice Address - Street 1:1229 MONROE AVE
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18509-2807
Practice Address - Country:US
Practice Address - Phone:570-346-8809
Practice Address - Fax:570-346-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier