Provider Demographics
NPI:1144311473
Name:KINETIC IMAGING, INC
Entity type:Organization
Organization Name:KINETIC IMAGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LADD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-960-3313
Mailing Address - Street 1:4520 UNION DEPOSIT RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2910
Mailing Address - Country:US
Mailing Address - Phone:717-652-6105
Mailing Address - Fax:717-652-2465
Practice Address - Street 1:45 SPRINT DR
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-7696
Practice Address - Country:US
Practice Address - Phone:717-960-3313
Practice Address - Fax:717-690-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047428L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10170914600001Medicaid
PA103651Medicare PIN