Organization
LACKAWANNA MOBILE X-RAY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL WOELKERS (PRESIDENT)
(570) 344-1112
Entity
Organization
Contact information
Practice address
1229 MONROE AVE, DUNMORE, PA 18509-2807
(570) 344-1112
(570) 344-7807
Mailing address
1229 MONROE AVE, DUNMORE, PA 18509-2807
(570) 344-1112
(570) 344-7807
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
—
0010364100001
—
PA
01
—
0526476
AETNA
PA
01
—
069499
FIRST PRIORITY HEALTH
PA
01
—
300004695
PALMETTO MEDICARE
PA
01
—
42654 3232
GEISINGER HEALTH PLAN
PA
Enumeration date
05/31/2006
Last updated
01/07/2014
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