Healthcare Provider Details

I. General information

NPI: 1275848921
Provider Name (Legal Business Name): PROFESSIONAL DIAGNOSTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9870 REDHILL DR
CINCINNATI OH
45242-5627
US

IV. Provider business mailing address

4380 MALSBARY RD SUITE 200
CINCINNATI OH
45242-5644
US

V. Phone/Fax

Practice location:
  • Phone: 513-745-5000
  • Fax: 513-791-7800
Mailing address:
  • Phone: 513-366-4481
  • Fax: 513-366-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS M RUSCITTO
Title or Position: CHIEF FINANCIAL OFFICIER
Credential:
Phone: 513-366-4945