Healthcare Provider Details

I. General information

NPI: 1598789000
Provider Name (Legal Business Name): NORTHEASTERN PENNSYLVANIA IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 STAFFORD AVE
SCRANTON PA
18505-0305
US

IV. Provider business mailing address

2601 STAFFORD AVE PO BOX 3305
SCRANTON PA
18505-0305
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-6633
  • Fax: 570-346-4049
Mailing address:
  • Phone: 570-346-6633
  • Fax: 570-346-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier000000072505
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUNISON
# 2
Identifier0032528
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA PIN NUMBER
# 3
Identifier1686
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER HEALTH PLAN
# 4
Identifier20010377
Identifier TypeOTHER
Identifier StatePA
Identifier Issuer20010377
# 5
Identifier0011162430005
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 6
IdentifierCB3186
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRAILROAD MEDICARE
# 7
Identifier053243
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY HEALTH
# 8
Identifier2Y6956
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPHS HEALTHNET
# 9
Identifier475385
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 10
Identifier999004
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE CROSS NE PA

VIII. Authorized Official

Name: JULIANN R. HALL
Title or Position: PRACTICE ADMINISTRATOR
Credential: MBA
Phone: 570-346-6633