Provider Demographics
NPI:1073512174
Name:MAHONING VALLEY IMAGING LTD
Entity Type:Organization
Organization Name:MAHONING VALLEY IMAGING LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-629-2366
Mailing Address - Street 1:PO BOX 182255
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-2255
Mailing Address - Country:US
Mailing Address - Phone:614-430-5730
Mailing Address - Fax:
Practice Address - Street 1:7067 TIFFANY BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1993
Practice Address - Country:US
Practice Address - Phone:330-629-2366
Practice Address - Fax:330-629-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340059212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2102861Medicaid
OH9303351Medicare PIN
OH9303352Medicare PIN
OH2102861Medicaid