Provider Demographics
NPI:1528058245
Name:EXTREMITY IMAGING PARTNERS INC
Entity type:Organization
Organization Name:EXTREMITY IMAGING PARTNERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:A JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGIACOBBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-398-7364
Mailing Address - Street 1:4500 BROOKTREE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9289
Mailing Address - Country:US
Mailing Address - Phone:866-398-7364
Mailing Address - Fax:866-267-0144
Practice Address - Street 1:4500 BROOKTREE RD
Practice Address - Street 2:STE 100
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9289
Practice Address - Country:US
Practice Address - Phone:866-398-7364
Practice Address - Fax:866-267-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200423690AMedicaid
PA258396OtherHEALTH ASSURANCE
PAPA255OtherONE CALL MEDICAL
OH000000340701OtherANTHEM BCBS
OH000000378160OtherANTHEM BCBS-DAYTON
PA1009572010004Medicaid
PA300686212OtherW/C US DEPT OF LABOR OWPC
OH2273614Medicaid
PA1009572010002Medicaid
PA7823651OtherAETNA
IN000000340701OtherANTHEM BCBS
PA1009572010001Medicaid
PA1009572010003Medicaid
OH000000378160OtherANTHEM BCBS-DAYTON
P00091063Medicare PIN
470001672Medicare PIN
PA258396OtherHEALTH ASSURANCE
OHID02115Medicare PIN
PA090195Medicare PIN
PA1009572010001Medicaid
OH000000340701OtherANTHEM BCBS
PA300686212OtherW/C US DEPT OF LABOR OWPC
KS9004228AMedicare PIN
PA1009572010002Medicaid
PA076392Medicare PIN