Healthcare Provider Details

I. General information

NPI: 1003855909
Provider Name (Legal Business Name): IMAGING RESOURCE CENTERS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2991 NEWMARK DR
MIAMISBURG OH
45342-5416
US

IV. Provider business mailing address

2991 NEWMARK DR
MIAMISBURG OH
45342-5416
US

V. Phone/Fax

Practice location:
  • Phone: 937-885-5840
  • Fax: 937-885-5863
Mailing address:
  • Phone: 937-424-9268
  • Fax: 937-424-9272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number06-E-04159-01
License Number StateOH

VIII. Authorized Official

Name: CHARLES ED YOUNG
Title or Position: OWNER/CEO
Credential:
Phone: 937-748-1514