Provider Demographics
NPI:1629199021
Name:VANGUARD IMAGING PARTNERS LLC
Entity Type:Organization
Organization Name:VANGUARD IMAGING PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER AND TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-9679
Mailing Address - Street 1:PO BOX 635500
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:937-748-8420
Mailing Address - Fax:937-748-8671
Practice Address - Street 1:630 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9553
Practice Address - Country:US
Practice Address - Phone:937-748-8420
Practice Address - Fax:937-748-8671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1306IC261QM1200X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00437849OtherRAILROAD MEDICARE
OH2742296Medicaid
OHID02854Medicare PIN