Provider Demographics
NPI:1992881023
Name:REGIONAL DIAGNOSTICS LLC
Entity type:Organization
Organization Name:REGIONAL DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR/GOVERNMENT PAYERS
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:EGED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-468-6010
Mailing Address - Street 1:4400 RENAISSANCE PKWY
Mailing Address - Street 2:SUITE L
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5763
Mailing Address - Country:US
Mailing Address - Phone:216-464-8484
Mailing Address - Fax:216-464-2444
Practice Address - Street 1:7515 FREDLE DR
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-9406
Practice Address - Country:US
Practice Address - Phone:216-464-8484
Practice Address - Fax:216-464-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2480506Medicaid
OH2480506Medicaid