Provider Demographics
NPI:1912940651
Name:LEBANON MRI ASSOCIATES, LTD
Entity Type:Organization
Organization Name:LEBANON MRI ASSOCIATES, LTD
Other - Org Name:GSH IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-270-7806
Mailing Address - Street 1:PO BOX 1336
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-1336
Mailing Address - Country:US
Mailing Address - Phone:717-270-4580
Mailing Address - Fax:717-270-4584
Practice Address - Street 1:4TH AND WALNUT STREETS
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-270-4580
Practice Address - Fax:717-270-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02389100OtherKEYSTONE HEALTH PLAN CENT
PA1408819OtherHIGHMARK BLUE SHIELD
PA305445OtherHEALTH AMER HEALTH ASSURA
PA01051013OtherAETNA
PA02389100OtherCAPITAL BLUE CROSS
PA1512966OtherGATEWAY HEALTH PLAN
PA02389100OtherCAPITAL BLUE CROSS
PA=========OtherTRICARE
PA02389100OtherCAPITAL BLUE CROSS