Provider Demographics
NPI:1124266556
Name:WESTERN HILLS MEDICAL IMAGING, INC.
Entity type:Organization
Organization Name:WESTERN HILLS MEDICAL IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFANOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-873-1915
Mailing Address - Street 1:3319 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-5618
Mailing Address - Country:US
Mailing Address - Phone:513-873-1915
Mailing Address - Fax:513-332-9375
Practice Address - Street 1:3319 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-5618
Practice Address - Country:US
Practice Address - Phone:513-873-1915
Practice Address - Fax:513-332-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2160049Medicaid
OH2160049Medicaid
OH2160049Medicaid
KY9375301Medicare PIN
IN200807610AMedicaid