1386632578 NPI number — REGIONAL DIAGNOSTICS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386632578 NPI number — REGIONAL DIAGNOSTICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL DIAGNOSTICS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386632578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4400 RENAISSANCE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44128-5763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-464-8484
Provider Business Mailing Address Fax Number:
216-468-6021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 AUBURN DR
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-4314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-464-7676
Provider Business Practice Location Address Fax Number:
216-464-6468
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
RON
Authorized Official Middle Name:
Authorized Official Title or Position:
C.F.O.
Authorized Official Telephone Number:
216-464-8484

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  0801IC , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2480499 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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