Provider Demographics
NPI:1114103504
Name:VITAL SCAN OF CENTRAL OHIO
Entity Type:Organization
Organization Name:VITAL SCAN OF CENTRAL OHIO
Other - Org Name:PREVAHEALTH WELLNESS DIAGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GILLBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GRADISAR
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:614-652-5888
Mailing Address - Street 1:5747 PERIMETER DR.
Mailing Address - Street 2:STE 105
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017
Mailing Address - Country:US
Mailing Address - Phone:614-652-5888
Mailing Address - Fax:614-652-5890
Practice Address - Street 1:5747 PERIMETER DR.
Practice Address - Street 2:STE 105
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017
Practice Address - Country:US
Practice Address - Phone:614-652-5888
Practice Address - Fax:614-652-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology