Provider Demographics
NPI:1104166966
Name:SUBURBAN DIAGNOSTIC CLINIC LLC
Entity type:Organization
Organization Name:SUBURBAN DIAGNOSTIC CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:ALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:248-593-9780
Mailing Address - Street 1:3830 WOODLEY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1177
Mailing Address - Country:US
Mailing Address - Phone:419-841-7766
Mailing Address - Fax:
Practice Address - Street 1:3830 WOODLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1177
Practice Address - Country:US
Practice Address - Phone:419-841-7766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography