Provider Demographics
NPI:1467442806
Name:REGIONAL AMBULATORY DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:REGIONAL AMBULATORY DIAGNOSTICS, INC.
Other - Org Name:DEACONESS HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF PROFESSIONAL SERV
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOVITT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:601-268-1842
Mailing Address - Street 1:PO BOX 15129
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-5129
Mailing Address - Country:US
Mailing Address - Phone:601-268-1842
Mailing Address - Fax:601-268-7898
Practice Address - Street 1:1008 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-2316
Practice Address - Country:US
Practice Address - Phone:513-281-1430
Practice Address - Fax:513-281-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0575793Medicaid
OH0575793Medicaid