Provider Demographics
NPI:1336255066
Name:RADIOLOGY SERVICES OF OHIO, INC.
Entity Type:Organization
Organization Name:RADIOLOGY SERVICES OF OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAZNECI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-734-3131
Mailing Address - Street 1:PO BOX 21610
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-0610
Mailing Address - Country:US
Mailing Address - Phone:800-923-7963
Mailing Address - Fax:614-771-2248
Practice Address - Street 1:615 FULTON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2001
Practice Address - Country:US
Practice Address - Phone:419-734-3131
Practice Address - Fax:614-771-2248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-6761-H2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9344771Medicare ID - Type UnspecifiedMEDICARE GROUP PRACTICE N