Provider Demographics
NPI:1487608634
Name:LMIC RADIOLOGY PARTNERSHIP
Entity type:Organization
Organization Name:LMIC RADIOLOGY PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:I
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-740-9500
Mailing Address - Street 1:1230 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6367
Mailing Address - Country:US
Mailing Address - Phone:610-740-0400
Mailing Address - Fax:610-437-6263
Practice Address - Street 1:1220 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-740-9500
Practice Address - Fax:610-740-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011127180009Medicaid
PA49954OtherAETNA US HEALTHCARE
PA03219800OtherCAPITAL BLUE CROSS
PA7100388OtherGATEWAY HEALTH PLAN
PA126106OtherUNISON
PA100388OtherHIGHMARK BLUE SHIELD
PW47983OtherAMERIHEALTH MERCY
PW0079277000OtherINDEPENDENCE
GACF3061Medicare PIN
PA100388Medicare PIN