Provider Demographics
NPI:1497706576
Name:VALLEY ADVANCED MRI LLC
Entity Type:Organization
Organization Name:VALLEY ADVANCED MRI 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:610-258-1200
Mailing Address - Street 1:2403 BUTLER ST
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 ST
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:2006-05-13
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA30540172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1522296OtherGATEWAY
2684292OtherAETNA US HEALTHCARE
VA1366772OtherHIGHMARK
03272900OtherCAPITAL BLUE CROSS
1366772OtherINDEPENDENCE BC PPO
PA178OtherONE CALL MEDICAL
PA001894533Medicaid
1367521OtherMEDIGAP BLUE SHIELD
130512OtherMEDPLUS THREE RIVERS
8853701OtherCIGNA
PAP00021587OtherRAILROAD MEDICARE
=========OtherPRIVATE HEALTHCARE SYSTEM
NJ=========OtherHORIZON BLUE CROSS BLUE SHIELD OF NEW JERSY
PAP00021587OtherRAILROAD MEDICARE
PA001894533Medicaid
130512OtherMEDPLUS THREE RIVERS
=========OtherTRICARE STANDARD
1366772OtherINDEPENDENCE BC PPO
=========OtherNJ MANUFACTURERS INS
VA1366772OtherHIGHMARK
=========OtherTRICARE STANDARD