Provider Demographics
NPI:1225026461
Name:REGIONAL DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:REGIONAL DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND COO
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-464-8484
Mailing Address - Street 1:4400 RENAISSANCE PKWY
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5763
Mailing Address - Country:US
Mailing Address - Phone:216-464-8484
Mailing Address - Fax:216-468-6021
Practice Address - Street 1:19250 E. BAGLEY RD.
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HTS.
Practice Address - State:OH
Practice Address - Zip Code:44130-3314
Practice Address - Country:US
Practice Address - Phone:440-260-9970
Practice Address - Fax:440-260-9980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1116IC261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1225ICOtherOH DEPT HEALTH
OH2528956Medicaid
OHREID02088Medicare ID - Type Unspecified