Provider Demographics
NPI:1881672434
Name:BRIGHTON RADIOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BRIGHTON RADIOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-728-6284
Mailing Address - Street 1:300 S WALNUT LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-1739
Mailing Address - Country:US
Mailing Address - Phone:724-728-6539
Mailing Address - Fax:724-728-7416
Practice Address - Street 1:1000 DUTCH RIDGE RD
Practice Address - Street 2:THE MEDICAL CENTER
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9727
Practice Address - Country:US
Practice Address - Phone:724-773-4567
Practice Address - Fax:724-728-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006873370Medicaid
PA0006873370004Medicaid
WV3810003808Medicaid
OH0562207Medicaid
PACF6444Medicare PIN
PA0006873370004Medicaid
PA0006873370Medicaid
OH9337212Medicare PIN
OH003265Medicare PIN
PA1008493Medicare PIN