Provider Demographics
NPI:1972593093
Name:PROSCAN TYLERSVILLE, LLC
Entity type:Organization
Organization Name:PROSCAN TYLERSVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-281-3400
Mailing Address - Street 1:7003 LOOMIS LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3898
Mailing Address - Country:US
Mailing Address - Phone:513-759-7350
Mailing Address - Fax:513-759-7351
Practice Address - Street 1:7003 LOOMIS LN
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45069-3898
Practice Address - Country:US
Practice Address - Phone:513-759-7350
Practice Address - Fax:513-759-7351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0868IC2085R0202X
261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2356203Medicaid
OH000000332731OtherANTHEM PIN
OH2356203Medicaid
OHID01611Medicare PIN