Healthcare Provider Details

I. General information

NPI: 1588705818
Provider Name (Legal Business Name): KUTZTOWN MEDICAL IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 NORMAL AVE SUITE 101
KUTZTOWN PA
19530-1640
US

IV. Provider business mailing address

333 NORMAL AVE SUITE 101
KUTZTOWN PA
19530-1640
US

V. Phone/Fax

Practice location:
  • Phone: 610-683-6262
  • Fax: 610-683-9101
Mailing address:
  • Phone: 610-683-6262
  • Fax: 610-683-9101

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: MRS. TAMMY H. COYLE
Title or Position: ADMINSTRATIVE ASSISTANT
Credential:
Phone: 610-770-1606