1770995854 NPI number — PROSCAN WOMENS IMAGING AT REDBANK LLC

Table of content: (NPI 1770995854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770995854 NPI number — PROSCAN WOMENS IMAGING AT REDBANK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROSCAN WOMENS IMAGING AT REDBANK 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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770995854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11594 SPRINGFIELD PIKE
Provider Second Line Business Mailing Address:
SUITE 26
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45246-3527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-772-7750
Provider Business Mailing Address Fax Number:
513-771-7760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11594 SPRINGFIELD PIKE
Provider Second Line Business Practice Location Address:
SUITE 26
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45246-3527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-772-7750
Provider Business Practice Location Address Fax Number:
513-771-7760
Provider Enumeration Date:
05/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
AMAYA
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
SR. DIRECTOR, CORP. ADMIN.
Authorized Official Telephone Number:
513-924-5174

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)





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