Provider Demographics
NPI:1922008416
Name:MEDSCAN OPEN MRI OF MIDDLETOWN LLC
Entity Type:Organization
Organization Name:MEDSCAN OPEN MRI OF MIDDLETOWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-422-7250
Mailing Address - Street 1:625 S BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-5113
Mailing Address - Country:US
Mailing Address - Phone:513-422-7250
Mailing Address - Fax:513-422-1325
Practice Address - Street 1:625 S BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5113
Practice Address - Country:US
Practice Address - Phone:513-422-7250
Practice Address - Fax:513-422-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2531219Medicaid
OHID02221Medicare ID - Type Unspecified