Healthcare Provider Details

I. General information

NPI: 1205235652
Provider Name (Legal Business Name): MOLECULAR IMAGING OF HAMILTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6949 GOOD SAMARITAN DR
CINCINNATI OH
45247-5204
US

IV. Provider business mailing address

4197 FULTON DR NW SUITE C
CANTON OH
44718-2819
US

V. Phone/Fax

Practice location:
  • Phone: 330-491-1490
  • Fax: 330-491-1466
Mailing address:
  • Phone: 330-491-1490
  • Fax: 330-491-1466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0827IC
License Number StateOH

VIII. Authorized Official

Name: MR. SHAWN J SMITH
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 330-526-0005