Provider Demographics
NPI:1871559310
Name:WILKES BARRE IMAGING, LLC
Entity type:Organization
Organization Name:WILKES BARRE IMAGING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-730-0050
Mailing Address - Street 1:101 GREENWOOD AVENUE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2624
Mailing Address - Country:US
Mailing Address - Phone:215-379-8458
Mailing Address - Fax:215-379-8461
Practice Address - Street 1:146 MUNDY STREET
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-824-9242
Practice Address - Fax:570-824-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001805918-0002Medicaid
PA470001718OtherRAILROAD MEDICARE
PA167431Medicare PIN
PA167431Medicare PIN
PA470001718Medicare PIN
PA038478Medicare PIN