Healthcare Provider Details

I. General information

NPI: 1306955117
Provider Name (Legal Business Name): MSN IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 W 150TH ST SUITE 101
CLEVELAND OH
44135-1362
US

IV. Provider business mailing address

4330 W 150TH ST SUITE 101
CLEVELAND OH
44135-1362
US

V. Phone/Fax

Practice location:
  • Phone: 216-688-8000
  • Fax: 216-688-0075
Mailing address:
  • Phone: 216-688-8000
  • Fax: 216-688-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number0607-IC
License Number StateOH

VIII. Authorized Official

Name: MS. JOYCE SCOTT
Title or Position: COO
Credential:
Phone: 216-688-8000