| Organization Name: | OLD TRAIL IMAGING, LLC |
| NPI Number: | 1558303016 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LINDA THOMS (OPERATIONS MANAGER) |
| Mailing Address: | 21 Susquehanna Valley Mall Drive Selinsgrove |
| State: | PA US |
| Postal Code: | 178708409 |
| Phone Number: | 5703744411 |
| Fax Number: | |
| NPI Enumeration Date: | 06/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RM1200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Magnetic Resonance Imaging (MRI) |
| Taxonomy Definition: | |