Healthcare Provider Details

I. General information

NPI: 1053306555
Provider Name (Legal Business Name): VALLEY OPEN MRI AND DIAGNOSTIC CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 3RD AVE
KINGSTON PA
18704-5802
US

IV. Provider business mailing address

451 3RD AVE
KINGSTON PA
18704-5802
US

V. Phone/Fax

Practice location:
  • Phone: 570-283-0528
  • Fax: 570-283-0199
Mailing address:
  • Phone: 570-283-0528
  • Fax: 570-283-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDRA DREVENIK
Title or Position: DIRECTOR PRACTICE OPERATIONS
Credential:
Phone: 570-283-0205