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General NPI Number Information
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NPI Number | 1558303016
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Entity Type | Organization
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Legal Business Name | OLD TRAIL IMAGING, LLC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 21 SUSQUEHANNA VALLEY MALL DRIVE
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City | SELINSGROVE
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State | PA
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Zip | 17870-8409
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Country | US
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Telephone | 570-374-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 21 SUSQUEHANNA VALLEY MALL DRIVE
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City | SELINSGROVE
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State | PA
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Zip | 17870-8409
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Country | US
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Telephone | 570-374-4411
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | LINDA THOMS
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Credential |
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Telephone | 570-374-4411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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