MEDICARE: PRECISON OPEN MRI, 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	2085R0202X	Diagnostic Radiology Physician		OH

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

General Provider Information

NPI Number	:	1518918374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISON OPEN MRI, LLC

Provider Business Mailing Address
First Line	:	3609 PARK EAST DR
Second Line	:	SUITE 101
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4331
Country	:	US
Telephone Number	:	216-360-8300
Fax Number	:	216-360-9498

Provider Business Practice Location Address
First Line	:	3609 PARK EAST DR
Second Line	:	SUITE 101
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4331
Country	:	US
Telephone Number	:	216-360-8300
Fax Number	:	216-360-9498

Authorized Official
Title or Position	:	PRESIDENT & COO
Name	:	RON CLARK
Credential	:
Telephone Number	:	216-765-8390

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	11/07/2007

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