Provider Demographics
NPI:1326094608
Name:AKRON REGIONAL PET SCAN LLC
Entity Type:Organization
Organization Name:AKRON REGIONAL PET SCAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:SAGE
Authorized Official - Middle Name:
Authorized Official - Last Name:YARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-493-9004
Mailing Address - Street 1:PO BOX 30516
Mailing Address - Street 2:LOCK BOX #105
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909
Mailing Address - Country:US
Mailing Address - Phone:888-328-4534
Mailing Address - Fax:
Practice Address - Street 1:3009 SMITH RD
Practice Address - Street 2:SUITE 350
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-2666
Practice Address - Country:US
Practice Address - Phone:330-670-9166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2389482Medicaid
OH2389482Medicaid