Provider Demographics
NPI:1487642856
Name:REGIONAL DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:REGIONAL DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PRINCIPLE AND MEDICAL DIRE
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-584-2900
Mailing Address - Street 1:4400 RENAISSANCE PKWY
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128
Mailing Address - Country:US
Mailing Address - Phone:216-464-8484
Mailing Address - Fax:216-464-2444
Practice Address - Street 1:5183 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2405
Practice Address - Country:US
Practice Address - Phone:440-720-3000
Practice Address - Fax:440-720-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0605IC261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2238804Medicaid
OH1223ICOtherOH DEPT OF HEALTH
OH2238804Medicaid