MEDICARE: JEANES RADIOLOGY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1417903717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEANES RADIOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	101 GREENWOOD AVE
Second Line	:	SUITE 151
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-2627
Country	:	US
Telephone Number	:	215-379-8458
Fax Number	:	215-379-8461

Provider Business Practice Location Address
First Line	:	15200 BUSTLETON AVE
Second Line	:	COUNTY LINE PLAZA
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-1120
Country	:	US
Telephone Number	:	215-676-6500
Fax Number	:	215-676-9753

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	VICTORIA SANCHEZ
Credential	:
Telephone Number	:	215-379-8458

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/22/2020

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