Healthcare Provider Details

I. General information

NPI: 1477693265
Provider Name (Legal Business Name): EXTENDED CARE DIAGNOSTICS LLC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 CARVER WOODS DR STE 6
BLUE ASH OH
45242-5536
US

IV. Provider business mailing address

4422 CARVER WOODS DR STE 6
BLUE ASH OH
45242-5536
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-3181
  • Fax: 513-891-3934
Mailing address:
  • Phone: 513-891-3181
  • Fax: 513-891-3934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name: STEVE GANOTE
Title or Position: OPERTIONS MANAGER
Credential:
Phone: 317-557-6165