Healthcare Provider Details

I. General information

NPI: 1386612752
Provider Name (Legal Business Name): POTTSTOWN IMAGING COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 MEDICAL DR
POTTSTOWN PA
19464-3241
US

IV. Provider business mailing address

PO BOX 501151
SAINT LOUIS MO
63150-1151
US

V. Phone/Fax

Practice location:
  • Phone: 610-327-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number163201
License Number StatePA

VIII. Authorized Official

Name: GARY NEWSOME
Title or Position: SENIOR VP, GROUP OPERATIONS
Credential:
Phone: 888-373-9600