Healthcare Provider Details

I. General information

NPI: 1427046739
Provider Name (Legal Business Name): REGIONAL DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 S HARLEM AVE
BRIDGEVIEW IL
60455-1318
US

IV. Provider business mailing address

4400 RENAISSANCE PKWY
WARRENSVILLE HTS. OH
44128-5763
US

V. Phone/Fax

Practice location:
  • Phone: 708-430-0044
  • Fax: 773-430-9694
Mailing address:
  • Phone: 216-464-8484
  • Fax: 216-468-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. RON CLARK
Title or Position: DIRECTOR, MANAGED CARE
Credential:
Phone: 216-464-8484