Provider Demographics
NPI:1386383529
Name:WEST PARK DIAGNOSTIC LLC
Entity type:Organization
Organization Name:WEST PARK DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. CLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-437-6191
Mailing Address - Street 1:571 PONE LANE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323
Mailing Address - Country:US
Mailing Address - Phone:814-437-6191
Mailing Address - Fax:814-437-6197
Practice Address - Street 1:571 PONE LANE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323
Practice Address - Country:US
Practice Address - Phone:814-437-6191
Practice Address - Fax:814-437-6197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Single Specialty