Provider Demographics
NPI:1508890591
Name:STEEL VALLEY DIVERSIFIED, INC
Entity Type:Organization
Organization Name:STEEL VALLEY DIVERSIFIED, INC
Other - Org Name:STEEL VALLEY PORTABLE X-RAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROTHERMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-575-7360
Mailing Address - Street 1:5136 TUSCARAWAS ST W
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-5016
Mailing Address - Country:US
Mailing Address - Phone:330-479-1908
Mailing Address - Fax:330-479-1933
Practice Address - Street 1:5136 TUSCARAWAS ST W
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-5016
Practice Address - Country:US
Practice Address - Phone:330-479-1908
Practice Address - Fax:330-479-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0208X
OH335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2215490Medicaid
OH2215490Medicaid