Provider Demographics
NPI:1477731073
Name:ST ELIZABETH SOUTHWOODS IMAGING LLC
Entity Type:Organization
Organization Name:ST ELIZABETH SOUTHWOODS IMAGING LLC
Other - Org Name:SOUTHWOODS IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:FULCINITI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:330-729-0357
Mailing Address - Street 1:250 DEBARTOLO PL
Mailing Address - Street 2:BLDG B
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-7004
Mailing Address - Country:US
Mailing Address - Phone:330-726-2595
Mailing Address - Fax:330-726-3249
Practice Address - Street 1:250 DEBARTOLO PL
Practice Address - Street 2:BLDG B
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-7004
Practice Address - Country:US
Practice Address - Phone:330-726-2595
Practice Address - Fax:330-726-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0056IC261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology