Provider Demographics
NPI:1578529079
Name:COLLEGE FIELDS MRI LLC
Entity Type:Organization
Organization Name:COLLEGE FIELDS MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-658-9700
Mailing Address - Street 1:130 ENCLAVE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-3208
Mailing Address - Country:US
Mailing Address - Phone:724-658-9700
Mailing Address - Fax:724-658-9666
Practice Address - Street 1:130 ENCLAVE DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-3208
Practice Address - Country:US
Practice Address - Phone:724-658-9700
Practice Address - Fax:724-658-9666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1398419OtherHIGHMARKBCBS
PA0019247120001Medicaid
PA0019247120001Medicaid
PACJ9682Medicare PIN