Organization Active NPI

Susquehanna Valley Diagnostic Imaging Inc.

  • Diagnostic Radiology Physician
  • Bloomsburg, PA
National Provider Identifier
1689959595
Registry record updated Oct 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SUSQUEHANNA VALLEY DIAGNOSTIC IMAGING INC.
Practice address
6850 Lows Rd
Bloomsburg, PA 17815-8708
Phone
(570) 784-6243
Fax
(570) 784-6242
NPI assigned
Oct 12, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2011

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

Authorized official

Name
Ty Williams
Title
Administrator
Phone
(570) 784-6243

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

6850 Lows Rd
Bloomsburg, PA 17815-8708

Mailing address

6850 Lows Rd
Bloomsburg, PA 17815-8708
Phone (570) 784-6243

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111201000165 PA Part B Supplier - Clinic/Group Practice 0547434599 Receives reassigned benefits from 5 practitioners
Practice locations: Bloomsburg, PA

National Provider Directory

National Provider Directory

Locations

6850 Lows Rd
Ste 317
Bloomsburg, PA 17815
Phone (570) 784-6243

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1318377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318377600000",
    "number": "1689959595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6850 LOWS RD",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178158708",
            "telephone_number": "570-784-6243",
            "fax_number": "570-784-6242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6850 LOWS RD",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178158708",
            "telephone_number": "570-784-6243",
            "fax_number": "570-784-6242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA VALLEY DIAGNOSTIC IMAGING INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-12",
        "last_updated": "2011-10-12",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "TY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "570-784-6243"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomsburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; 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.