Healthcare Provider Details

I. General information

NPI: 1508944513
Provider Name (Legal Business Name): DIAGNOSTIC X-RAY SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 MAIN ST
BUFFALO NY
14214-1722
US

IV. Provider business mailing address

1769 W 26TH ST
ERIE PA
16508-1256
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-6280
  • Fax:
Mailing address:
  • Phone: 800-446-9729
  • Fax: 814-459-6386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JACOB RUSSELL WUERSTLE
Title or Position: PRESIDENT
Credential:
Phone: 814-459-6280