Provider Demographics
NPI:1861453276
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 LANE
Mailing Address - Street 2:STE G40
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025
Mailing Address - Country:US
Mailing Address - Phone:412-469-8950
Mailing Address - Fax:412-469-8980
Practice Address - Street 1:1200 BROOKS LANE
Practice Address - Street 2:STE G40
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025
Practice Address - Country:US
Practice Address - Phone:412-469-8950
Practice Address - Fax:412-469-8980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008795530001Medicaid
PA1592294OtherHIGHMARK
PA2215435OtherFIRST HEALTH
PA99959030OtherRAILROAD MEDICARE
PA99959030OtherRAILROAD MEDICARE