Basic Information
| Provider Information | |||||||||
| NPI: | 1245231240 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH BRIDGE IMAGING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 809 FARSON STREET | ||||||||
| Address2: | UNIT 107 | ||||||||
| City: | BELPRE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457141066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044220405 | ||||||||
| FaxNumber: | 3044854466 | ||||||||
| Practice Location | |||||||||
| Address1: | 809 FARSON STREET | ||||||||
| Address2: | UNIT 107 | ||||||||
| City: | BELPRE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457141066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044220405 | ||||||||
| FaxNumber: | 3044854466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | CONLEY | ||||||||
| AuthorizedOfficialFirstName: | YALE | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3044220405 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
ID Information
| ID | Type | State | Issuer | Description | 6802006000 | 05 | WV | MEDICAID | 2402877 | 01 | OH | MEDICAID | OTHER |