1649223223 NPI number — CINCINNATI MEDICAL IMAGING

Table of content: (NPI 1649223223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649223223 NPI number — CINCINNATI MEDICAL IMAGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CINCINNATI MEDICAL IMAGING
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:
KENWOOD MEDICAL IMAGING
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:
1649223223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4170 ROSSLYN DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45209-1197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-686-8000
Provider Business Mailing Address Fax Number:
513-686-8004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8154 MONTGOMERY RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45236-2968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-872-4500
Provider Business Practice Location Address Fax Number:
513-527-0416
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUDEPOHL
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
R
Authorized Official Title or Position:
SECRETARY/TREASURER
Authorized Official Telephone Number:
413-872-4500

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  1130910 , 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: 2221223 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 86000122 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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