Provider Demographics
NPI:1447240502
Name:CINCINNATI IMAGING LEASING COMPANY, LTD.
Entity Type:Organization
Organization Name:CINCINNATI IMAGING LEASING COMPANY, LTD.
Other - Org Name:PROSCAN IMAGING MIDTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR COPRORATE ADMIN
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:513-924-2101
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:877-776-7226
Mailing Address - Fax:
Practice Address - Street 1:5400 KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-2664
Practice Address - Country:US
Practice Address - Phone:877-776-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0805IC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2066937Medicaid
KY86000528Medicaid
OH2066937Medicaid