MEDICARE: WSO IMAGING CENTER LP

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	2085B0100X	Body Imaging Physician	NONE	PA
2	2085P0229X	Pediatric Radiology Physician	NONE	PA
3	2085R0202X	Diagnostic Radiology Physician	NONE	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1912993817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WSO IMAGING CENTER LP

Provider Business Mailing Address
First Line	:	629D LOWTHER RD
Second Line	:
City	:	LEWISBERRY
State	:	PA
Zip	:	17339-9527
Country	:	US
Telephone Number	:	717-938-2765
Fax Number	:	717-932-3095

Provider Business Practice Location Address
First Line	:	405 SAINT JOHNS CHURCH RD
Second Line	:
City	:	CAMP HILL
State	:	PA
Zip	:	17011-5739
Country	:	US
Telephone Number	:	717-761-7470
Fax Number	:	717-761-6291

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELIZABETH A BERGEY
Credential	:	MD
Telephone Number	:	717-938-2765

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	01/21/2009

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