Provider Demographics
NPI:1598789000
Name:NORTHEASTERN PENNSYLVANIA IMAGING CENTER
Entity Type:Organization
Organization Name:NORTHEASTERN PENNSYLVANIA IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIANN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:570-346-6633
Mailing Address - Street 1:2601 STAFFORD AVE
Mailing Address - Street 2:PO BOX 3305
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-0305
Mailing Address - Country:US
Mailing Address - Phone:570-346-6633
Mailing Address - Fax:570-346-4049
Practice Address - Street 1:2601 STAFFORD AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-0305
Practice Address - Country:US
Practice Address - Phone:570-346-6633
Practice Address - Fax:570-346-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000072505OtherUNISON
PA0032528OtherAETNA PIN NUMBER
PA1686OtherGEISINGER HEALTH PLAN
PA20010377Other20010377
PA0011162430005Medicaid
PACB3186OtherRAILROAD MEDICARE
PA053243OtherFIRST PRIORITY HEALTH
PA2Y6956OtherPHS HEALTHNET
PA475385OtherHIGHMARK BLUE SHIELD
PA999004OtherBLUE CROSS NE PA
PA999004OtherBLUE CROSS NE PA