1144218462 NPI number — REGIONAL DIAGNOSTICS, LLC

Table of content: (NPI 1144218462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144218462 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:
1144218462
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:
WARRENSVILLE HEIGHTS
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:
16236 PRINCE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH HOLLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60473-3233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-333-1400
Provider Business Practice Location Address Fax Number:
708-333-0110
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:
DIRECTOR, MANAGED CARE
Authorized Official Telephone Number:
216-464-8484

Provider Taxonomy Codes

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

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