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General NPI Number Information
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NPI Number | 1912993817
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Entity Type | Organization
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Legal Business Name | WSO IMAGING CENTER LP
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 405 SAINT JOHNS CHURCH RD
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City | CAMP HILL
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State | PA
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Zip | 17011-5739
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Country | US
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Telephone | 717-761-7470
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Fax | 717-761-6291
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Provider Business Mailing Address
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Address Line | 629D LOWTHER RD
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City | LEWISBERRY
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State | PA
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Zip | 17339-9527
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Country | US
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Telephone | 717-938-2765
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Fax | 717-932-3095
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIZABETH A BERGEY
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Credential | MD
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Telephone | 717-938-2765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | NONE
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | NONE
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | NONE
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License Number State | PA
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