Provider Demographics
NPI:1285729129
Name:THE IMAGING CENTER AT GOOD SHEPHERD
Entity type:Organization
Organization Name:THE IMAGING CENTER AT GOOD SHEPHERD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:STUPPINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-778-1060
Mailing Address - Street 1:850 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3308
Mailing Address - Country:US
Mailing Address - Phone:610-778-1060
Mailing Address - Fax:610-778-1065
Practice Address - Street 1:850 S 5TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3308
Practice Address - Country:US
Practice Address - Phone:610-778-1060
Practice Address - Fax:610-778-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00380223OtherRAILROAD MEDICARE
PA357901Medicaid
PA107609Medicare PIN