Provider Demographics
NPI:1013991827
Name:RAINTREE MRI SERVICES INC
Entity Type:Organization
Organization Name:RAINTREE MRI SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GHAZANFAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-375-3261
Mailing Address - Street 1:PO BOX 1106
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0906
Mailing Address - Country:US
Mailing Address - Phone:814-371-1784
Mailing Address - Fax:814-371-4812
Practice Address - Street 1:100 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1440
Practice Address - Country:US
Practice Address - Phone:814-371-1784
Practice Address - Fax:814-371-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4348OtherGEISINGER CLASS
PA0015335220008Medicaid
P029588OtherTRICARE CLASS
641205OtherBLUE SHIELD CLASS
=========OtherUMWA CLASS
P029588OtherTRICARE CLASS
=========OtherRR MEDICARE CLASS
=========00OtherOHIO WKC CLASS