Healthcare Provider Details

I. General information

NPI: 1972593093
Provider Name (Legal Business Name): PROSCAN TYLERSVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7003 LOOMIS LN
LIBERTY TOWNSHIP OH
45069-3898
US

IV. Provider business mailing address

7003 LOOMIS LN
LIBERTY TOWNSHIP OH
45069-3898
US

V. Phone/Fax

Practice location:
  • Phone: 513-759-7350
  • Fax: 513-759-7351
Mailing address:
  • Phone: 513-759-7350
  • Fax: 513-759-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0868IC
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAREN AMAYA
Title or Position: COO
Credential:
Phone: 513-281-3400