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NPI Code Detail

MEDICARE: INDEPENDENCE IMAGING, LLC

MEDICARE: INDEPENDENCE IMAGING, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0200XRadiology Clinic/Center

General Provider Information

NPI Number : 1396084497
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDEPENDENCE IMAGING, LLC
Provider Business Mailing Address
First Line : 1200 CONSTITUTION AVE
Second Line : SUITE 120
City : PHILADELPHIA
State : PA
Zip : 19112-1329
Country : US
Telephone Number : 215-755-1076
Fax Number : 215-755-2167
Provider Business Practice Location Address
First Line : 1200 CONSTITUTION AVE
Second Line : SUITE 120
City : PHILADELPHIA
State : PA
Zip : 19112-1329
Country : US
Telephone Number : 215-755-1076
Fax Number : 215-755-2167
Authorized Official
Title or Position : PARTNER
Name : MRS. CHRISTINE CHILA HAWKINSON
Credential : MBA
Telephone Number : 215-755-1076
Provider Enumeration Date : 02/08/2013
Last Update Date : 08/04/2014

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Directions to “INDEPENDENCE IMAGING, LLC ” Practice Location

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