Provider Demographics
NPI:1033160197
Name:SUBURBAN RADIOLOGY LIMI
Entity Type:Organization
Organization Name:SUBURBAN RADIOLOGY LIMI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-726-6010
Mailing Address - Street 1:PO BOX 14280
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-7280
Mailing Address - Country:US
Mailing Address - Phone:330-726-6010
Mailing Address - Fax:330-726-6017
Practice Address - Street 1:10655 WASHINGTONVILLE RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9448
Practice Address - Country:US
Practice Address - Phone:330-726-6010
Practice Address - Fax:330-726-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006305C2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0179131Medicaid
OHCR0791449Medicare ID - Type Unspecified
OHG14785Medicare UPIN