Provider Demographics
NPI:1619965910
Name:REGIONAL DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:REGIONAL DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND COO
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-464-8484
Mailing Address - Street 1:4400 RENAISSANCE PKWY
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5763
Mailing Address - Country:US
Mailing Address - Phone:216-464-8484
Mailing Address - Fax:216-468-6021
Practice Address - Street 1:4220 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-3618
Practice Address - Country:US
Practice Address - Phone:740-266-3131
Practice Address - Fax:740-266-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1063IC261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2162225Medicaid
OH1227ICOtherOH DEPT HEALTH
OH1227ICOtherOH DEPT HEALTH
OHREID02061Medicare ID - Type Unspecified