Provider Demographics
NPI:1982725826
Name:VANGUARD IMAGING PARTNERS LLC
Entity Type:Organization
Organization Name:VANGUARD IMAGING PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER AND TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-9679
Mailing Address - Street 1:PO BOX 635500
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:937-208-7411
Mailing Address - Fax:937-208-7412
Practice Address - Street 1:1525 E STROOP RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-5065
Practice Address - Country:US
Practice Address - Phone:937-208-7411
Practice Address - Fax:937-208-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QR0200X, 261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00437849OtherRAILROAD MEDICARE
OH2756398Medicaid
OHID02855Medicare PIN