Provider Demographics
NPI:1164423133
Name:SUMMIT DIAGNOSTICS
Entity Type:Organization
Organization Name:SUMMIT DIAGNOSTICS
Other - Org Name:MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLIENT SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-965-8041
Mailing Address - Street 1:PO BOX 42172
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-0172
Mailing Address - Country:US
Mailing Address - Phone:513-965-8041
Mailing Address - Fax:513-965-8091
Practice Address - Street 1:12037 SHERATON LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1611
Practice Address - Country:US
Practice Address - Phone:513-965-8041
Practice Address - Fax:513-965-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2165035Medicaid
OH2165026Medicaid
OHID00663Medicare PIN
OH2165035Medicaid
OH9351481Medicare PIN