Healthcare Provider Details

I. General information

NPI: 1407270515
Provider Name (Legal Business Name): TRI STATE IMAGING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 THREE LITTLE BAKERS BLVD
WILMINGTON DE
19808-1754
US

IV. Provider business mailing address

2840 PINE RD SUITE D1
HUNTINGDON VALLEY PA
19006-4258
US

V. Phone/Fax

Practice location:
  • Phone: 215-967-1079
  • Fax:
Mailing address:
  • Phone: 215-967-1049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOUISA KIPERVAS
Title or Position: PRESIDENT
Credential:
Phone: 215-967-1079