Provider Demographics
NPI:1457433849
Name:FIRELANDS RADIOLOGY, INC
Entity Type:Organization
Organization Name:FIRELANDS RADIOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-668-3349
Mailing Address - Street 1:54 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-9566
Mailing Address - Country:US
Mailing Address - Phone:418-668-3349
Mailing Address - Fax:419-663-6541
Practice Address - Street 1:54 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-9566
Practice Address - Country:US
Practice Address - Phone:418-668-3349
Practice Address - Fax:419-663-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-04-20
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
OH0517266Medicaid
OHCF4994OtherRR MEDICARE
OH0517266Medicaid
OH=========00OtherWORKERS COMP