Lackawanna Mobile X-Ray, Inc.

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

Legal business name

LACKAWANNA MOBILE X-RAY, INC.

Practice address

1229 Monroe Ave
Dunmore, PA 18509-2807

Phone

(800) 789-7082

Fax

(800) 801-7684

NPI assigned

Sep 14, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paul Woelkers

Title

President

Phone

(570) 346-5115

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in PA, MD2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Lackawanna Mobile X-Ray Inc

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Dunmore, PA
  • NPI 1497702609

  5991760746

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Lackawanna Mobile X-Ray Inc

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Dunmore, PA
  • NPI 1497702609

  O20070504000326

  Same enrollment

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Peter G Gregory, MD

  • Diagnostic Radiology Physician
  • Clarks Summit, PA
  • NPI 1639285521
  NPD
• Madhava S Rao, MD

  • Cardiovascular Disease Physician
  • Scranton, PA
  • NPI 1902896210
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1063607893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 MONROE AVE",
            "city": "DUNMORE",
            "state": "PA",
            "postal_code": "185092807",
            "telephone_number": "800-789-7082",
            "fax_number": "800-801-7684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 MONROE AVE",
            "city": "DUNMORE",
            "state": "PA",
            "postal_code": "185092807",
            "telephone_number": "800-789-7082",
            "fax_number": "800-801-7684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LACKAWANNA MOBILE X-RAY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-14",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "WOELKERS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-346-5115",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0526476",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "2771012000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO MEDICARE",
            "identifier": "300004695",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "2771012000",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010364100002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE 65",
            "identifier": "2771012000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CHOICE",
            "identifier": "2771012000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "50002829",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven Kravitz, PA
• Amy L Kreckman, MSW, LSW
• Emily Kuchwara, MS, LAPC, NCC, CADC
• Atef W Labeeb, MD
• Lackawanna Mobile X-Ray Inc
• Lackawanna X-Ray, LLC
• Lisa Ann Lanteigne-Kornetka, LMSW
• Laporta and Associates,PC
• Guido A Laporta, DPM
• Joel J Laury, M.D.

• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Dunmore, PA
• Providers in Dunmore, PA by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.