1588654610 NPI number — PROSCAN RADIOLOGY, LLC

Table of content: (NPI 1588654610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588654610 NPI number — PROSCAN RADIOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROSCAN RADIOLOGY, LLC
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:
1588654610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5400 KENNEDY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45213-2664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-281-3400
Provider Business Mailing Address Fax Number:
513-527-2275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 KENNEDY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45213-2664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-281-3400
Provider Business Practice Location Address Fax Number:
513-527-2275
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WALLACE
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
513-281-3400

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: 4401045 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 954728 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810007868 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0027626 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20002178 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03733011 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65940819 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: QPB842 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2552956 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 298152 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1008658800001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7136252 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com