Healthcare Provider Details

I. General information

NPI: 1184677890
Provider Name (Legal Business Name): RADIOLOGY AND IMAGING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 W MARKET ST STE 210
AKRON OH
44313-4205
US

IV. Provider business mailing address

PO BOX 931286
CLEVELAND OH
44193-1494
US

V. Phone/Fax

Practice location:
  • Phone: 330-864-0832
  • Fax:
Mailing address:
  • Phone: 888-719-9012
  • Fax: 330-493-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DORIS STOUT
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-344-1400