Provider Demographics
NPI:1639364334
Name:RAMIC BOARDMAN, LLC
Entity Type:Organization
Organization Name:RAMIC BOARDMAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-495-4821
Mailing Address - Street 1:1449 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-8061
Mailing Address - Country:US
Mailing Address - Phone:330-965-7370
Mailing Address - Fax:330-965-7377
Practice Address - Street 1:1449 BOARDMAN CANFIELD RD
Practice Address - Street 2:SUITE 140
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-8061
Practice Address - Country:US
Practice Address - Phone:330-965-7370
Practice Address - Fax:330-965-7377
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AIMI IMAGING SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-06
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0838IC261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2938030Medicaid
OH2938030Medicaid