MEDICARE: REGIONAL DIAGNOSTICS, 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

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	:	1669460820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	4400 RENAISSANCE PKWY
Second Line	:
City	:	WARRENSVILLE HTS
State	:	OH
Zip	:	44128-5763
Country	:	US
Telephone Number	:	216-464-8484
Fax Number	:	216-464-2444

Provider Business Practice Location Address
First Line	:	730 SOM CENTER RD
Second Line	:	SUITE 220
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-2350
Country	:	US
Telephone Number	:	770-720-3990
Fax Number	:	440-720-3989

Authorized Official
Title or Position	:	C.F.O.
Name	:	MR. RON CLARK
Credential	:
Telephone Number	:	216-464-8484

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	08/22/2020

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Directions to “REGIONAL DIAGNOSTICS, LLC ” Practice Location

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