1871595066 NPI number — MOLECULAR IMAGING OF HAMILTON

Table of content: (NPI 1871595066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871595066 NPI number — MOLECULAR IMAGING OF HAMILTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOLECULAR IMAGING OF HAMILTON
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:
MOLECULAR IMAGING OF HAMILTON COUNTY, LLC
Provider Other Organization Name Type Code:
5
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:
1871595066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20347
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44701-0347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-491-1490
Provider Business Mailing Address Fax Number:
330-491-1466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4197 FULTON DR NW
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44718-2819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-491-1490
Provider Business Practice Location Address Fax Number:
330-491-1466
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SECRETARY/TREASURER
Authorized Official Telephone Number:
330-526-0005

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0827IC , 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)





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