Provider Demographics
NPI:1477605905
Name:LAUREL HIGHLANDS ADVANCED IMAGING, LLC
Entity Type:Organization
Organization Name:LAUREL HIGHLANDS ADVANCED IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-539-5987
Mailing Address - Street 1:239 MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1640
Mailing Address - Country:US
Mailing Address - Phone:814-539-5987
Mailing Address - Fax:814-535-4176
Practice Address - Street 1:1450 SCALP AVE
Practice Address - Street 2:SUITE 001
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3374
Practice Address - Country:US
Practice Address - Phone:814-539-5987
Practice Address - Fax:814-535-4176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001834160Medicaid
PA043517Medicare ID - Type UnspecifiedPA MEDICARE