Healthcare Provider Details

I. General information

NPI: 1629199021
Provider Name (Legal Business Name): VANGUARD IMAGING PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N MAIN ST
SPRINGBORO OH
45066-9553
US

IV. Provider business mailing address

PO BOX 635500
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-748-8420
  • Fax: 937-748-8671
Mailing address:
  • Phone: 937-748-8420
  • Fax: 937-748-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number1306IC
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number1306IC
License Number StateOH

VIII. Authorized Official

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