Provider Demographics
NPI:1770622870
Name:MONROEVILLE DIAGNOSTIC IMAGING SPECIALISTS LLC
Entity type:Organization
Organization Name:MONROEVILLE DIAGNOSTIC IMAGING SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-935-6280
Mailing Address - Street 1:3824 NORTHERN PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146
Mailing Address - Country:US
Mailing Address - Phone:412-457-0060
Mailing Address - Fax:412-457-0067
Practice Address - Street 1:3824 NORTHERN PIKE
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146
Practice Address - Country:US
Practice Address - Phone:412-373-6342
Practice Address - Fax:412-373-6347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012938680001Medicaid
001736377OtherHIGHMARK
1547029OtherGATEWAY
P00271297OtherRAILROAD MEDICARE
7593730OtherAETNA
PA1012938680001Medicaid