MEDICARE: PROSCAN IMAGING GAHANNA, 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	0768IC	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	:	1912997032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSCAN IMAGING GAHANNA, LLC

Provider Business Mailing Address
First Line	:	5400 KENNEDY AVE
Second Line	:	ATTN: CREDENTIALING
City	:	CINCINNATI
State	:	OH
Zip	:	45213-2664
Country	:	US
Telephone Number	:	513-281-3400
Fax Number	:	513-527-2275

Provider Business Practice Location Address
First Line	:	5593 N HAMILTON RD
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-1321
Country	:	US
Telephone Number	:	614-855-8740
Fax Number	:	614-855-8745

Authorized Official
Title or Position	:	SENIOR DIRECTOR, CORPORATE ADMIN.
Name	:	KAREN E AMAYA
Credential	:
Telephone Number	:	513-924-5174

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	09/28/2015

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