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NPI Code Detail

MEDICARE: WYOMING VALLEY PET ASSOCIATES

MEDICARE: WYOMING VALLEY PET ASSOCIATES
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 : 1720066392
Entity Type Code : Organization
Provider Name (Legal Business Name) : WYOMING VALLEY PET ASSOCIATES
Provider Business Mailing Address
First Line : 43 LEOPARD RD
Second Line : SUITE 200
City : PAOLI
State : PA
Zip : 19301-1552
Country : US
Telephone Number : 610-993-1640
Fax Number : 610-993-1651
Provider Business Practice Location Address
First Line : 190 WELLES ST
Second Line :
City : FORTY FORT
State : PA
Zip : 18704-4968
Country : US
Telephone Number : 570-331-7702
Fax Number : 570-331-7704
Authorized Official
Title or Position : DIRECTOR OF BILLING
Name : MR. EDWARD J GRACE
Credential :
Telephone Number : 610-993-1640
Provider Enumeration Date : 01/04/2006
Last Update Date : 06/18/2008

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Directions to “WYOMING VALLEY PET ASSOCIATES ” Practice Location

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