Provider Demographics
NPI:1649223223
Name:CINCINNATI MEDICAL IMAGING
Entity Type:Organization
Organization Name:CINCINNATI MEDICAL IMAGING
Other - Org Name:KENWOOD MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUDEPOHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-872-4500
Mailing Address - Street 1:4170 ROSSLYN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1197
Mailing Address - Country:US
Mailing Address - Phone:513-686-8000
Mailing Address - Fax:513-686-8004
Practice Address - Street 1:8154 MONTGOMERY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2968
Practice Address - Country:US
Practice Address - Phone:513-872-4500
Practice Address - Fax:513-527-0416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11309102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2221223Medicaid
KY86000122Medicaid
OH2221223Medicaid