Provider Demographics
NPI:1528058260
Name:NORTH OHIO MEDICAL IMAGING
Entity type:Organization
Organization Name:NORTH OHIO MEDICAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WISWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-808-9729
Mailing Address - Street 1:2211 CROCKER RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-7602
Mailing Address - Country:US
Mailing Address - Phone:440-808-9729
Mailing Address - Fax:440-892-0425
Practice Address - Street 1:2211 CROCKER RD
Practice Address - Street 2:SUITE 140
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-7602
Practice Address - Country:US
Practice Address - Phone:440-808-9729
Practice Address - Fax:440-892-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2629007Medicaid
OH2629007Medicaid