Provider Demographics
NPI:1619123858
Name:REGIONAL DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:REGIONAL DIAGNOSTICS, LLC
Other - Org Name:SPECTRUM DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-584-2900
Mailing Address - Street 1:4760 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5978
Mailing Address - Country:US
Mailing Address - Phone:216-765-8390
Mailing Address - Fax:216-765-8392
Practice Address - Street 1:4760 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5978
Practice Address - Country:US
Practice Address - Phone:216-765-8390
Practice Address - Fax:216-765-8392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHID03461Medicare PIN