Provider Demographics
NPI:1003855909
Name:IMAGING RESOURCE CENTERS LTD
Entity Type:Organization
Organization Name:IMAGING RESOURCE CENTERS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ED
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-748-1514
Mailing Address - Street 1:2991 NEWMARK DR
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-5416
Mailing Address - Country:US
Mailing Address - Phone:937-424-9268
Mailing Address - Fax:937-424-9272
Practice Address - Street 1:2991 NEWMARK DR
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-5416
Practice Address - Country:US
Practice Address - Phone:937-885-5840
Practice Address - Fax:937-885-5863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06-E-04159-01261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200479060AMedicaid
OH2067534Medicaid
IN214830Medicare ID - Type Unspecified
IN200479060AMedicaid
OH2067534Medicaid
OHID00251Medicare ID - Type Unspecified