Provider Demographics
NPI:1700049400
Name:CONCORD IMAGING AT THE QUARRY, PA
Entity Type:Organization
Organization Name:CONCORD IMAGING AT THE QUARRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:N
Authorized Official - Last Name:WIERSIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-572-2222
Mailing Address - Street 1:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1907
Mailing Address - Country:US
Mailing Address - Phone:800-945-2455
Mailing Address - Fax:
Practice Address - Street 1:423 TREELINE PARK
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1997
Practice Address - Country:US
Practice Address - Phone:210-572-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty