Provider Demographics
NPI:1063274280
Name:IMAGEAMERICAPA
Entity type:Organization
Organization Name:IMAGEAMERICAPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-249-1745
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:ALBRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18210-0014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 TAMARACK TER
Practice Address - Street 2:
Practice Address - City:ALBRIGHTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18210-3826
Practice Address - Country:US
Practice Address - Phone:215-584-1119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory