Healthcare Provider Details

I. General information

NPI: 1164907655
Provider Name (Legal Business Name): USA RADIOLOGY OF PENNSYLVANIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 LIBERTY ST
MEADVILLE PA
16335-2559
US

IV. Provider business mailing address

PO BOX 2153 DEPT 5627
BIRMINGHAM AL
35287-5627
US

V. Phone/Fax

Practice location:
  • Phone: 314-238-5260
  • Fax:
Mailing address:
  • Phone: 314-238-5260
  • Fax: 314-821-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK BARRON
Title or Position: CEO
Credential:
Phone: 314-238-5260