Provider Demographics
NPI:1811170541
Name:SUMMIT DIAGNOSTIC IMAGING LLC
Entity type:Organization
Organization Name:SUMMIT DIAGNOSTIC IMAGING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-233-3320
Mailing Address - Street 1:PO BOX 54512
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45254-0512
Mailing Address - Country:US
Mailing Address - Phone:513-231-8885
Mailing Address - Fax:513-231-5607
Practice Address - Street 1:7755 5 MILE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2355
Practice Address - Country:US
Practice Address - Phone:513-233-3320
Practice Address - Fax:513-233-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000074611OtherANTHEM
OH2165017Medicaid
OH=========-02OtherBWC
OH000000074611OtherANTHEM
OH=========006OtherMEDICAL MUTUAL
OH2165017Medicaid
OH2165017Medicaid