Provider Demographics
NPI:1235671710
Name:CITRAN XRAY LLC
Entity Type:Organization
Organization Name:CITRAN XRAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:937-864-7363
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:ENON
Mailing Address - State:OH
Mailing Address - Zip Code:45323-0339
Mailing Address - Country:US
Mailing Address - Phone:937-340-6488
Mailing Address - Fax:937-340-6512
Practice Address - Street 1:7774 DAYTON SPRINGFIELD ROAD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-1996
Practice Address - Country:US
Practice Address - Phone:937-340-6488
Practice Address - Fax:937-340-6512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10-C-18902-001261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology