Provider Demographics
NPI:1992945935
Name:DIAGNOSTIC IMAGING CENTERS OF NEPA, LLC
Entity type:Organization
Organization Name:DIAGNOSTIC IMAGING CENTERS OF NEPA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING/CONTRACTING
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:M
Authorized Official - Last Name:BODNAR
Authorized Official - Suffix:
Authorized Official - Credentials:RCC
Authorized Official - Phone:570-504-2519
Mailing Address - Street 1:1000 MEADE ST
Mailing Address - Street 2:MEDICAL PLAZA
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-3195
Mailing Address - Country:US
Mailing Address - Phone:570-504-2519
Mailing Address - Fax:570-504-2599
Practice Address - Street 1:111 HULST DR
Practice Address - Street 2:STE 708
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336-2115
Practice Address - Country:US
Practice Address - Phone:570-491-9200
Practice Address - Fax:570-491-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty