Provider Demographics
NPI:1689959595
Name:SUSQUEHANNA VALLEY DIAGNOSTIC IMAGING INC.
Entity Type:Organization
Organization Name:SUSQUEHANNA VALLEY DIAGNOSTIC IMAGING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-784-6243
Mailing Address - Street 1:6850 LOWS RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8708
Mailing Address - Country:US
Mailing Address - Phone:570-784-6243
Mailing Address - Fax:570-784-6242
Practice Address - Street 1:6850 LOWS RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8708
Practice Address - Country:US
Practice Address - Phone:570-784-6243
Practice Address - Fax:570-784-6242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty