Healthcare Provider Details

I. General information

NPI: 1790765204
Provider Name (Legal Business Name): BELLEFONTAINE RADIOLOGIST ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N EASTOWN RD
LIMA OH
45807-2268
US

IV. Provider business mailing address

PO BOX 5500
LONGVIEW TX
75608-5500
US

V. Phone/Fax

Practice location:
  • Phone: 419-998-4498
  • Fax:
Mailing address:
  • Phone: 903-663-4800
  • Fax: 419-229-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000000347016
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerANTHEM
# 2
Identifier2521613
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: HASSAN B SEMAAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 937-592-4015