Provider Demographics
NPI:1528069556
Name:WARREN RADIOLOGY ASSOCIATES INC
Entity type:Organization
Organization Name:WARREN RADIOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER WRA
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:H
Authorized Official - Last Name:KUHNEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-723-3300
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-0456
Mailing Address - Country:US
Mailing Address - Phone:814-723-1689
Mailing Address - Fax:814-723-9276
Practice Address - Street 1:2-12 CRESCENT PARK
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2221
Practice Address - Country:US
Practice Address - Phone:814-723-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0722605Medicaid
PACF7672Medicare PIN
PA091497Medicare PIN