Provider Demographics
NPI:1184677890
Name:RADIOLOGY AND IMAGING SERVICES
Entity Type:Organization
Organization Name:RADIOLOGY AND IMAGING SERVICES
Other - Org Name:REFLECTIONS VEIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-1400
Mailing Address - Street 1:PO BOX 931286
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-1494
Mailing Address - Country:US
Mailing Address - Phone:888-719-9012
Mailing Address - Fax:330-493-7123
Practice Address - Street 1:2603 W MARKET ST
Practice Address - Street 2:STE 210
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-4205
Practice Address - Country:US
Practice Address - Phone:330-864-0832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIOLOGY & IMAGING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0474606Medicaid
OHCN1167OtherRAILROAD MEDICARE GROUP LEGACY
OH9290071Medicare PIN