Provider Demographics
NPI:1073571238
Name:PROSCAN IMAGING OF TROY, LLC
Entity Type:Organization
Organization Name:PROSCAN IMAGING OF TROY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:AMAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-924-5174
Mailing Address - Street 1:810 FALLS CREEK DR STE A
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-8600
Mailing Address - Country:US
Mailing Address - Phone:937-440-6781
Mailing Address - Fax:937-440-9734
Practice Address - Street 1:810 FALLS CREEK DR STE A
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-8600
Practice Address - Country:US
Practice Address - Phone:937-440-6781
Practice Address - Fax:937-440-9734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1217IC2085R0202X
261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000388577OtherANTHEM PIN
OH2697630Medicaid
OHID02841Medicare PIN