MEDICARE: MEDSCAN OPEN MRI OF MIDDLETOWN 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	261QM1200X	Magnetic Resonance Imaging (MRI) 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	:	1922008416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSCAN OPEN MRI OF MIDDLETOWN LLC

Provider Business Mailing Address
First Line	:	625 S BREIEL BLVD
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-5113
Country	:	US
Telephone Number	:	513-422-7250
Fax Number	:	513-422-1325

Provider Business Practice Location Address
First Line	:	625 S BREIEL BLVD
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-5113
Country	:	US
Telephone Number	:	513-422-7250
Fax Number	:	513-422-1325

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MITA MORAR
Credential	:
Telephone Number	:	513-422-7250

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	08/22/2020

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