Healthcare Provider Details

I. General information

NPI: 1356598817
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING CENTERS OF NEPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1789 N KEYSER AVE
SCRANTON PA
18508-1250
US

IV. Provider business mailing address

1000 MEADE ST
DUNMORE PA
18512
US

V. Phone/Fax

Practice location:
  • Phone: 570-504-2500
  • Fax: 570-504-2599
Mailing address:
  • Phone: 570-504-2519
  • Fax: 570-504-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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:

VIII. Authorized Official

Name: MRS. LORI M BODNAR
Title or Position: BILLING SUPERVISOR
Credential: R.C.C.
Phone: 570-504-2519