Basic Information
| Provider Information | |||||||||
| NPI: | 1760436976 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANTHRACITE IMAGING ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 BRIGGS RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080544100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562314774 | ||||||||
| FaxNumber: | 8562319699 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 E NORWEGIAN ST | ||||||||
| Address2: | RADIOLOGY DEPARTMENT | ||||||||
| City: | POTTSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179012710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706214052 | ||||||||
| FaxNumber: | 5706214155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WHITMOYER | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 5706214420 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0202X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | 1011866520001 | 05 | PA | MEDICAID |