Provider Demographics
NPI:1952394363
Name:IMAGING PROFESSIONALS OF PENNSYLVANIA PC
Entity Type:Organization
Organization Name:IMAGING PROFESSIONALS OF PENNSYLVANIA PC
Other - Org Name:CALLOWHILL OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-663-5910
Mailing Address - Street 1:PO BOX 827275
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-7275
Mailing Address - Country:US
Mailing Address - Phone:215-663-5910
Mailing Address - Fax:215-663-2451
Practice Address - Street 1:301 CALLOWHILL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-4103
Practice Address - Country:US
Practice Address - Phone:215-574-9400
Practice Address - Fax:215-574-1563
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMAGING PROFESSONALS OF PENNSYLVANIA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-31
Last Update Date:2022-07-21
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
PA0011008510021Medicaid
PA0011008510021Medicaid