Provider Demographics
NPI:1942208475
Name:DENRIC WESTERVILLE LLC
Entity Type:Organization
Organization Name:DENRIC WESTERVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENY
Authorized Official - Middle Name:
Authorized Official - Last Name:RADEFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-933-9351
Mailing Address - Street 1:PO BOX 633849
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-3849
Mailing Address - Country:US
Mailing Address - Phone:866-287-3726
Mailing Address - Fax:
Practice Address - Street 1:640 W SCHROCK RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8996
Practice Address - Country:US
Practice Address - Phone:614-818-9332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2550565Medicaid
OHP00054309OtherRR MEDICARE PIN
OH000000319533OtherBC/BS GROUP PIN NUMBER
OH000000319533OtherBC/BS GROUP PIN NUMBER