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General NPI Number Information
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NPI Number | 1992945935
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC IMAGING CENTERS OF NEPA, LLC
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | 111 HULST DR STE 708
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City | MATAMORAS
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State | PA
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Zip | 18336-2115
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Country | US
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Telephone | 570-491-9200
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Fax | 570-491-9201
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Provider Business Mailing Address
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Address Line | 1000 MEADE ST MEDICAL PLAZA
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City | DUNMORE
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State | PA
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Zip | 18512-3195
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Country | US
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Telephone | 570-504-2519
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Fax | 570-504-2599
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Authorized Official
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Title or Position | DIRECTOR OF BILLING/CONTRACTING
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Name | MRS. LORI M BODNAR
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Credential | RCC
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Telephone | 570-504-2519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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