MEDICARE: TRI-STATE CARDIOVASCULAR IMAGING ASSOCIATES, INC.

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
2	2471V0105X	Vascular Sonography Radiologic Technologist
3	261QR0208X	Mobile Radiology Clinic/Center	PA-1134	PA

General Provider Information

NPI Number	:	1619113610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STATE CARDIOVASCULAR IMAGING ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	3502 SCOTTS LN
Second Line	:	SUITE 2
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1561
Country	:	US
Telephone Number	:	215-842-0870
Fax Number	:	215-974-7466

Provider Business Practice Location Address
First Line	:	3502 SCOTTS LN
Second Line	:	SUITE 2
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1561
Country	:	US
Telephone Number	:	215-842-0870
Fax Number	:	215-974-7466

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL TITAYEVSKY
Credential	:
Telephone Number	:	215-842-0870

Provider Enumeration Date	:	12/21/2008
Last Update Date	:	12/21/2008

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