MEDICARE: VALLEY ADVANCED 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
1	2471N0900X	Nuclear Medicine Technology Radiologic Technologist	3054015	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00110029	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2035663000	OTHER	INDEPENDENCE BLUE CROSS H
3	2572590	OTHER	AETNA US HEALTHCARE HMO
5	VA1339666	OTHER	PA BLUE SHIELD
6	118732	OTHER	THREE RIVERS HEALTH PLANS
7	001339666	OTHER	INDEPENDENCE BLUE CROSS P
8	002104142	OTHER	UNITED HEALTHCARE
9	02986400	OTHER	CAPITAL ADVANTAGE INSURAN
10	7633253	OTHER	AETNA US HEALTHCARE TRADI

General Provider Information

NPI Number	:	1417907023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY ADVANCED IMAGING LLC

Provider Business Mailing Address
First Line	:	2403 BUTLER STREET
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18042
Country	:	US
Telephone Number	:	610-258-1200
Fax Number	:	610-258-1106

Provider Business Practice Location Address
First Line	:	2403 BUTLER STREET
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18042
Country	:	US
Telephone Number	:	610-258-1200
Fax Number	:	610-258-1106

Authorized Official
Title or Position	:	CEO OWNER
Name	:	MR. JAMES J STUPPINO
Credential	:
Telephone Number	:	610-865-4738

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	05/15/2008

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Directions to “VALLEY ADVANCED IMAGING LLC ” Practice Location

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