Basic Information
| Provider Information | |||||||||
| NPI: | 1518928506 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHAMPTON IMAGING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 W CHEW ST | ||||||||
| Address2: | PHYSICIAN ACCOUNTS | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106633441 | ||||||||
| FaxNumber: | 6106633170 | ||||||||
| Practice Location | |||||||||
| Address1: | 602 E 21ST ST | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180671259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102626622 | ||||||||
| FaxNumber: | 6102626432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 08/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | SPLAIN | ||||||||
| AuthorizedOfficialFirstName: | SPLAIN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6106633441 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0017514500004 | 05 | PA | MEDICAID | 03161600 | 01 | PA | CBC GROUP NUMBER | OTHER | 20021128 | 01 | AMERIHEALTH MERCY | OTHER | 0040634000 | 01 | IBC | OTHER | 475764 | 01 | PA | HIGHMARK BS GROUP NUMBER | OTHER | CC7763 | 01 | RR MEDICARE # | OTHER | 1520160 | 01 | GATEWAY HEALTH PLAN | OTHER |