Provider Demographics
NPI:1821141102
Name:MANSFIELD IMAGING CENTER LLC
Entity Type:Organization
Organization Name:MANSFIELD IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-522-3400
Mailing Address - Street 1:536 S TRIMBLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3418
Mailing Address - Country:US
Mailing Address - Phone:419-774-9729
Mailing Address - Fax:419-774-0006
Practice Address - Street 1:536 S TRIMBLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3418
Practice Address - Country:US
Practice Address - Phone:419-774-9729
Practice Address - Fax:419-774-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2500494Medicaid
OHP00070031OtherRR MEDICARE
OH2500494Medicaid