MEDICARE: CITRAN XRAY 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	261QR0200X	Radiology Clinic/Center	10-C-18902-001	OH

General Provider Information

NPI Number	:	1235671710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITRAN XRAY LLC

Provider Business Mailing Address
First Line	:	PO BOX 339
Second Line	:
City	:	ENON
State	:	OH
Zip	:	45323-0339
Country	:	US
Telephone Number	:	937-340-6488
Fax Number	:	937-340-6512

Provider Business Practice Location Address
First Line	:	7774 DAYTON SPRINGFIELD ROAD
Second Line	:
City	:	FAIRBORN
State	:	OH
Zip	:	45324-1996
Country	:	US
Telephone Number	:	937-340-6488
Fax Number	:	937-340-6512

Authorized Official
Title or Position	:	OWNER
Name	:	EILEEN DEAN
Credential	:	R.N.
Telephone Number	:	937-864-7363

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	11/15/2016

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