MEDICARE: PROSCAN IMAGING OF TROY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center
2	2085R0202X	Diagnostic Radiology Physician	1217IC	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000388577	OTHER		ANTHEM PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073571238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSCAN IMAGING OF TROY, LLC

Provider Business Mailing Address
First Line	:	810 FALLS CREEK DR STE A
Second Line	:
City	:	VANDALIA
State	:	OH
Zip	:	45377-8600
Country	:	US
Telephone Number	:	937-440-6781
Fax Number	:	937-440-9734

Provider Business Practice Location Address
First Line	:	810 FALLS CREEK DR STE A
Second Line	:
City	:	VANDALIA
State	:	OH
Zip	:	45377-8600
Country	:	US
Telephone Number	:	937-440-6781
Fax Number	:	937-440-9734

Authorized Official
Title or Position	:	COO
Name	:	KAREN E AMAYA
Credential	:
Telephone Number	:	513-924-5174

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	10/20/2023

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