Provider Demographics
NPI:1225028392
Name:PROSCAN OPEN MRI NORTH, LTD.
Entity Type:Organization
Organization Name:PROSCAN OPEN MRI NORTH, LTD.
Other - Org Name:PROSCAN IMAGING TRI-COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR, CORPORATE ADMINISTRAT
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 1:5400 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11596 SPRINGFIELD PIKE
Practice Address - Street 2:SUITE 27
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-3527
Practice Address - Country:US
Practice Address - Phone:513-671-7800
Practice Address - Fax:513-671-7870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0496IC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2141275Medicaid
OH2141275Medicaid