Provider Demographics
NPI:1316943657
Name:RENAISSANCE MEDICAL IMAGING, PLLC
Entity type:Organization
Organization Name:RENAISSANCE MEDICAL IMAGING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:SKEENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-551-3188
Mailing Address - Street 1:4197 FULTON DR NW
Mailing Address - Street 2:STE C
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2819
Mailing Address - Country:US
Mailing Address - Phone:330-491-1490
Mailing Address - Fax:330-491-1466
Practice Address - Street 1:2908 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1962
Practice Address - Country:US
Practice Address - Phone:800-551-3188
Practice Address - Fax:606-920-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY380072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9552Medicare ID - Type Unspecified