MEDICARE: KUTZTOWN MEDICAL IMAGING

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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1588705818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KUTZTOWN MEDICAL IMAGING

Provider Business Mailing Address
First Line	:	333 NORMAL AVE
Second Line	:	SUITE 101
City	:	KUTZTOWN
State	:	PA
Zip	:	19530-1640
Country	:	US
Telephone Number	:	610-683-6262
Fax Number	:	610-683-9101

Provider Business Practice Location Address
First Line	:	333 NORMAL AVE
Second Line	:	SUITE 101
City	:	KUTZTOWN
State	:	PA
Zip	:	19530-1640
Country	:	US
Telephone Number	:	610-683-6262
Fax Number	:	610-683-9101

Authorized Official
Title or Position	:	ADMINSTRATIVE ASSISTANT
Name	:	MRS. TAMMY H. COYLE
Credential	:
Telephone Number	:	610-770-1606

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	08/22/2020

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Directions to “KUTZTOWN MEDICAL IMAGING ” Practice Location

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