Provider Demographics
NPI:1336205707
Name:PROSCAN RADIOLOGY, LLC
Entity Type:Organization
Organization Name:PROSCAN RADIOLOGY, LLC
Other - Org Name:PROSCAN IMAGING GAHANNA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:N
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-924-5183
Mailing Address - Street 1:425 BEECHER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6778
Mailing Address - Country:US
Mailing Address - Phone:614-855-8740
Mailing Address - Fax:
Practice Address - Street 1:425 BEECHER RD
Practice Address - Street 2:SUITE B
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6778
Practice Address - Country:US
Practice Address - Phone:614-855-8740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHID00814Medicare ID - Type Unspecified