Healthcare Provider Details

I. General information

NPI: 1134128085
Provider Name (Legal Business Name): REGIONAL PET SCAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ALBURN DR SUITE 100
BEACHWOOD OH
44122-4314
US

IV. Provider business mailing address

3733 PARK EAST DR SUITE 100
BEACHWOOD OH
44122-4338
US

V. Phone/Fax

Practice location:
  • Phone: 216-464-1917
  • Fax:
Mailing address:
  • Phone: 216-292-9998
  • Fax: 216-292-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number1094IC
License Number StateOH

VIII. Authorized Official

Name: MRS. NANCY WESTRICH
Title or Position: MANAGING PARTNER
Credential:
Phone: 847-920-0500