Provider Demographics
NPI:1720042344
Name:JRMC DIAGNOSTIC SERVICES LLC
Entity Type:Organization
Organization Name:JRMC DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-205-6095
Mailing Address - Street 1:1200 BROOKS LN
Mailing Address - Street 2:SUITE G60
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3747
Mailing Address - Country:US
Mailing Address - Phone:412-469-8952
Mailing Address - Fax:412-469-8957
Practice Address - Street 1:1200 BROOKS LN
Practice Address - Street 2:SUITE G60
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3747
Practice Address - Country:US
Practice Address - Phone:412-469-8952
Practice Address - Fax:412-469-8957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA373036801293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013056OtherGATEWAY CARDIOLOGY
PA149313OtherUNISON
PA233963OtherHEALTH AMERICA
PA1040021OtherGATEWAY RADIOLOGY
1553170OtherHIGHMARK
PA2116525OtherFIRST HEALTH
AETNAOther3481040
PA075043Medicare ID - Type Unspecified