Healthcare Provider Details

I. General information

NPI: 1649318643
Provider Name (Legal Business Name): EVENDALE ANCILLARY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3147 GLENDALE MILFORD ROAD
CINCINNATI OH
45241
US

IV. Provider business mailing address

3147 GLENDALE MILFORD ROAD
CINCINNATI OH
45241
US

V. Phone/Fax

Practice location:
  • Phone: 513-247-8800
  • Fax: 513-247-8805
Mailing address:
  • Phone: 513-247-8800
  • Fax: 513-247-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELVIN G HANGER
Title or Position: CAMPUS ADMINISTRATOR
Credential:
Phone: 513-247-8800