Healthcare Provider Details

I. General information

NPI: 1285714717
Provider Name (Legal Business Name): MEDICAL IMAGING NETWORK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 MCKAY CT
BOARDMAN OH
44512-5713
US

IV. Provider business mailing address

819 MCKAY CT
BOARDMAN OH
44512-5713
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-9006
  • Fax: 330-726-2061
Mailing address:
  • Phone: 330-726-9006
  • Fax: 330-726-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.050931
License Number StateOH

VIII. Authorized Official

Name: DR. ALBERT M BLEGGI
Title or Position: PERSIDENT
Credential: M.D.
Phone: 330-726-9006