MEDICARE: PROSCAN OPEN MRI EAST, LTD.

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	470001875	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861482911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSCAN OPEN MRI EAST, LTD.

Provider Business Mailing Address
First Line	:	4440 GLEN ESTE WITHAMSVILLE RD
Second Line	:	SUITE 1100
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1318
Country	:	US
Telephone Number	:	513-947-9801
Fax Number	:	513-947-8911

Provider Business Practice Location Address
First Line	:	4440 GLEN ESTE WITHAMSVILLE RD
Second Line	:	SUITE 1100
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1318
Country	:	US
Telephone Number	:	513-281-3400
Fax Number	:	513-527-2275

Authorized Official
Title or Position	:	SR. DIR. CORP. ADMIN.
Name	:	MRS. KAREN E AMAYA
Credential	:
Telephone Number	:	513-924-5174

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	06/26/2013

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