Healthcare Provider Details

I. General information

NPI: 1548946122
Provider Name (Legal Business Name): MANSA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 HICKORY LN
MORELAND HILLS OH
44022-1901
US

IV. Provider business mailing address

162 HICKORY LN
MORELAND HILLS OH
44022-1901
US

V. Phone/Fax

Practice location:
  • Phone: 440-465-9375
  • Fax:
Mailing address:
  • Phone: 440-465-9375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MARTIN RODGERS
Title or Position: CCO
Credential:
Phone: 440-465-9375