Provider Demographics
NPI:1124144878
Name:YOUNGSTOWN ASSOCIATES IN RADIOLOGY INC
Entity type:Organization
Organization Name:YOUNGSTOWN ASSOCIATES IN RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-758-8353
Mailing Address - Street 1:7250 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4346
Mailing Address - Country:US
Mailing Address - Phone:330-758-8353
Mailing Address - Fax:330-758-0369
Practice Address - Street 1:7250 WEST BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4346
Practice Address - Country:US
Practice Address - Phone:330-758-8353
Practice Address - Fax:330-758-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0116IC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0812599Medicaid
OHYO9932781Medicare ID - Type Unspecified