Organization
LACKAWANNA MOBILE X-RAY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL WOELKERS (PRESIDENT)
(570) 346-5115
Entity
Organization
Contact information
Practice address
1229 MONROE AVE, DUNMORE, PA 18509-2807
(800) 789-7082
(800) 801-7684
Mailing address
1229 MONROE AVE, DUNMORE, PA 18509-2807
(800) 789-7082
(800) 801-7684
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010364100002
—
PA
01
—
0526476
AETNA
PA
01
—
2771012000
AMERIHEALTH
PA
01
—
300004695
PALMETTO MEDICARE
PA
01
—
50002829
CAPITAL BLUE CROSS
PA
Enumeration date
09/14/2007
Last updated
05/09/2008
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