Provider Demographics
NPI:1770644569
Name:MEDPRO MEDICAL IMAGING
Entity Type:Organization
Organization Name:MEDPRO MEDICAL IMAGING
Other - Org Name:CT MRI ASSOCIATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-885-5770
Mailing Address - Street 1:5660 MONROE ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2733
Mailing Address - Country:US
Mailing Address - Phone:419-885-5770
Mailing Address - Fax:419-885-5414
Practice Address - Street 1:5660 MONROE ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2733
Practice Address - Country:US
Practice Address - Phone:419-885-5770
Practice Address - Fax:419-885-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology