Provider Demographics
NPI:1316999121
Name:RADIOLOGY AND IMAGING SERVICES
Entity type:Organization
Organization Name:RADIOLOGY AND IMAGING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-1400
Mailing Address - Street 1:PO BOX 931286
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-1494
Mailing Address - Country:US
Mailing Address - Phone:888-719-9012
Mailing Address - Fax:330-493-7123
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:SUITE 3500
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2433
Practice Address - Country:US
Practice Address - Phone:330-344-1400
Practice Address - Fax:330-344-0112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIOLOGY AND IMAGING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCC3678OtherRAILROAD MEDICARE GROUP
OH2622139Medicaid
OHCC3678OtherRAILROAD MEDICARE GROUP