Provider Demographics
NPI:1396781365
Name:PROFESSIONAL RAADIOLOGY INC
Entity type:Organization
Organization Name:PROFESSIONAL RAADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUDEPOHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-527-0401
Mailing Address - Street 1:4170 ROSSLYN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1197
Mailing Address - Country:US
Mailing Address - Phone:513-872-4500
Mailing Address - Fax:513-872-4518
Practice Address - Street 1:3125 HAMILTON MASON RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-5307
Practice Address - Country:US
Practice Address - Phone:513-872-4500
Practice Address - Fax:513-872-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3162042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0395095Medicaid
KY65916447Medicaid