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NPI Code Detail

MEDICARE: DIAGNOSTIC X-RAY SERVICE, INC.

MEDICARE: DIAGNOSTIC X-RAY SERVICE, INC.
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
1335V00000XPortable X-ray and/or Other Portable Diagnostic Imaging Supplier

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699853606
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIAGNOSTIC X-RAY SERVICE, INC.
Provider Business Mailing Address
First Line : 1769 W 26TH ST
Second Line :
City : ERIE
State : PA
Zip : 16508-1256
Country : US
Telephone Number : 800-446-9729
Fax Number : 814-459-6386
Provider Business Practice Location Address
First Line : 2828 MAIN ST
Second Line :
City : BUFFALO
State : NY
Zip : 14214-1722
Country : US
Telephone Number : 814-459-6280
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JACOB RUSSELL WUERSTLE
Credential :
Telephone Number : 814-459-6280
Provider Enumeration Date : 11/01/2006
Last Update Date : 09/23/2024

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