Healthcare Provider Details

I. General information

NPI: 1861512725
Provider Name (Legal Business Name): VANGUARD IMAGING PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2007
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7271 N MAIN ST
DAYTON OH
45415-2567
US

IV. Provider business mailing address

PO BOX 635500
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-276-8000
  • Fax: 937-276-8008
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number1259IC
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number1259IC
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number1259IC
License Number StateOH

VIII. Authorized Official

Name: SCOTT A BUCHANAN
Title or Position: CONTROLLER AND TREASURER
Credential:
Phone: 937-208-9679