1144279613 NPI number — TRUMBULL RADIOLOGISTS INC

Table of content: (NPI 1144279613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144279613 NPI number — TRUMBULL RADIOLOGISTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRUMBULL RADIOLOGISTS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144279613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9360 RIVER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARCY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13403-2070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-698-1700
Provider Business Mailing Address Fax Number:
330-841-5858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TRUMBULL RADIOLOGISTS INC
Provider Second Line Business Practice Location Address:
2588 STATE ROUTE 5
Provider Business Practice Location Address City Name:
COURTLAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44410-9653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-841-5807
Provider Business Practice Location Address Fax Number:
330-841-5858
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOGES
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
330-841-5807

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0043303 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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