Provider Demographics
NPI:1912908849
Name:MILLENNIUM RADIOLOGY INC
Entity type:Organization
Organization Name:MILLENNIUM RADIOLOGY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZIPPERER-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-347-7237
Mailing Address - Street 1:PO BOX 636298
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6298
Mailing Address - Country:US
Mailing Address - Phone:513-347-7237
Mailing Address - Fax:513-347-6567
Practice Address - Street 1:4983 DELHI AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-5380
Practice Address - Country:US
Practice Address - Phone:513-347-7237
Practice Address - Fax:513-347-6567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200424180AMedicaid
KY65939209Medicaid
OH2664077Medicaid
OH2335324Medicaid
IN200424180AMedicaid
OH2664077Medicaid