| Organization Name: | WYOMING VALLEY PET ASSOCIATES |
| NPI Number: | 1720066392 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDWARD J GRACE (DIRECTOR OF BILLING) |
| Mailing Address: | 190 Welles St Forty Fort |
| State: | PA US |
| Postal Code: | 187044968 |
| Phone Number: | 5703317702 |
| Fax Number: | 5703317704 |
| NPI Enumeration Date: | 01/04/2006 |
| NPI Last Update Date: | 06/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology |
| Taxonomy Definition: | |