Healthcare Provider Details

I. General information

NPI: 1700852001
Provider Name (Legal Business Name): CLARION IMAGE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
CLARION PA
16214-8501
US

IV. Provider business mailing address

PO BOX 506
CLARION PA
16214-0506
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0016066000008
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier952173
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUECROSS/BLUESHIELD

VIII. Authorized Official

Name: MRS. SHARON DOROTHY SPENCE
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 814-864-9932