Organization
TRI COUNTY IMAGING ASSOC. LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE WATTS (OFFICE ADMINISTRATOR)
(814) 444-1918
Entity
Organization
Contact information
Practice address
10455 LINCOLN HWY, EVERETT, PA 15537-7046
(814) 444-1918
(814) 444-9782
Mailing address
PO BOX 1198, SOMERSET, PA 15501-0336
(814) 444-1918
(814) 444-9782
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000063834
—
PA
05
—
0011325600010
—
PA
01
—
0113399000
PERSONAL CHOICE
PA
01
—
106739
UPMC
PA
05
—
1509635
—
PA
01
—
526016
HIGHMARK BLUE SHIELD
PA
05
—
699866600
—
MD
Enumeration date
11/30/2005
Last updated
04/30/2014
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