Provider Demographics
NPI:1679665772
Name:MSN IMAGING PROFESSIONALS, INC
Entity Type:Organization
Organization Name:MSN IMAGING PROFESSIONALS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-688-8000
Mailing Address - Street 1:4330 W 150TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-1362
Mailing Address - Country:US
Mailing Address - Phone:216-688-8000
Mailing Address - Fax:216-688-0075
Practice Address - Street 1:4330 W 150TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-1362
Practice Address - Country:US
Practice Address - Phone:216-688-8000
Practice Address - Fax:216-688-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0534372085R0202X
OH34-0534372085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0629172Medicaid
OH000000169054OtherANTHEM
OH92915OtherQUALCHOICE
OH0629172Medicaid
OH92915OtherQUALCHOICE