Provider Demographics
NPI:1265430060
Name:TRI-STATE MOBILE X-RAY INC
Entity type:Organization
Organization Name:TRI-STATE MOBILE X-RAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MURSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-881-9333
Mailing Address - Street 1:4684 CLAIRTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-2114
Mailing Address - Country:US
Mailing Address - Phone:412-881-9333
Mailing Address - Fax:412-881-3522
Practice Address - Street 1:4684 CLAIRTON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-2114
Practice Address - Country:US
Practice Address - Phone:412-881-9333
Practice Address - Fax:412-881-3522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA66071Medicaid
PA0027846OtherAETNA
PA0008535090002Medicaid
PA14969OtherELDERCARE
PA310954OtherHIGHMARK
PA021129Medicare ID - Type Unspecified
FLK0318Medicare ID - Type Unspecified
PA14969OtherELDERCARE
PA0027846OtherAETNA
PA1288202Medicare ID - Type UnspecifiedUMWA