MEDICARE: MSN IMAGING, 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	0607-IC	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	470000589	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	87025	OTHER	OH	QUALCHOICE
3	000000232755	OTHER	OH	ANTHEM PROVIDER NUMBER
4	101137	OTHER	OH	KAISER
5	1600085	OTHER	OH	UNITEDHEALTHCARE
6	7874099	OTHER	OH	AETNA PROVIDER NUMBER
8	6523202	OTHER	OH	CIGNA

General Provider Information

NPI Number	:	1306955117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSN IMAGING, LLC

Provider Business Mailing Address
First Line	:	4330 W 150TH ST
Second Line	:	SUITE 101
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1362
Country	:	US
Telephone Number	:	216-688-8000
Fax Number	:	216-688-0075

Provider Business Practice Location Address
First Line	:	4330 W 150TH ST
Second Line	:	SUITE 101
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1362
Country	:	US
Telephone Number	:	216-688-8000
Fax Number	:	216-688-0075

Authorized Official
Title or Position	:	COO
Name	:	MS. JOYCE SCOTT
Credential	:
Telephone Number	:	216-688-8000

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	09/30/2011

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Directions to “MSN IMAGING, LLC ” Practice Location

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