1588869929 NPI number — FSH RADIOLOGY INC

Table of content: (NPI 1588869929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588869929 NPI number — FSH RADIOLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FSH RADIOLOGY INC
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:
1588869929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 PARK EAST DR
Provider Second Line Business Mailing Address:
SUITE #300
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-4305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-236-2649
Provider Business Mailing Address Fax Number:
877-631-3043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 PARK EAST DR
Provider Second Line Business Practice Location Address:
SUITE #300
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-4305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-236-2649
Provider Business Practice Location Address Fax Number:
877-631-3043
Provider Enumeration Date:
06/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SEIDELMANN
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
216-255-5700

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 413791 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2763997 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5911930 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: DP9327 . This is a "RXR GRP PTAN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 28007042 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1370584 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5911513 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000946000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100069090 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807660703 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: DQ1028 . This is a "RXR MCR PTAN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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