1467442806 NPI number — REGIONAL AMBULATORY DIAGNOSTICS, INC.

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 1467442806 NPI number — REGIONAL AMBULATORY DIAGNOSTICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL AMBULATORY DIAGNOSTICS, 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:
DEACONESS HOME HEALTH CARE
Provider Other Organization Name Type Code:
3
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:
1467442806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATTIESBURG
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39404-5129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-268-1842
Provider Business Mailing Address Fax Number:
601-268-7898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1008 MARSHALL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45225-2316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-281-1430
Provider Business Practice Location Address Fax Number:
513-281-1409
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LOVITT
Authorized Official First Name:
PENNY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
VICE PRESIDENT OF PROFESSIONAL SERV
Authorized Official Telephone Number:
601-268-1842

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0575793 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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