Healthcare Provider Details

I. General information

NPI: 1285087288
Provider Name (Legal Business Name): TRI STATE IMAGING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 PINE RD SUITE D1
HUNTINGDON VALLEY PA
19006-4258
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: 215-967-1077
Mailing address:
  • Phone: 215-967-1079
  • Fax: 215-967-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

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