Provider Demographics
NPI:1700884160
Name:DIAGNOSTIC RADIOLOGY INCORPORATED
Entity Type:Organization
Organization Name:DIAGNOSTIC RADIOLOGY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHLBRINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-544-1544
Mailing Address - Street 1:PO BOX 711919
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-0001
Mailing Address - Country:US
Mailing Address - Phone:866-286-5884
Mailing Address - Fax:
Practice Address - Street 1:3000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1921
Practice Address - Country:US
Practice Address - Phone:513-732-8587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0417374Medicaid
OH000000004661OtherBC BS
OH2538285Medicaid
OHCD2623OtherRAILROAD MEDICARE
OHCC2080OtherRAILROAD MEDICARE
OH2538481Medicaid
OHCC2080OtherRAILROAD MEDICARE