Provider Demographics
NPI:1063585628
Name:SEVERANCE RADIOLOGY SERVICES, INC.
Entity type:Organization
Organization Name:SEVERANCE RADIOLOGY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-382-7165
Mailing Address - Street 1:5 SEVERANCE CIR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1566
Mailing Address - Country:US
Mailing Address - Phone:216-382-7165
Mailing Address - Fax:216-382-7166
Practice Address - Street 1:5 SEVERANCE CIR
Practice Address - Street 2:SUITE 207
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1566
Practice Address - Country:US
Practice Address - Phone:216-382-7165
Practice Address - Fax:216-382-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH09913601779Medicaid
OH9269991Medicare ID - Type Unspecified