Healthcare Provider Details

I. General information

NPI: 1215044094
Provider Name (Legal Business Name): RADIOLOGY AND IMAGING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 WADSWORTH RD
WADSWORTH OH
44281-9504
US

IV. Provider business mailing address

PO BOX 931286
CLEVELAND OH
44193-1494
US

V. Phone/Fax

Practice location:
  • Phone: 330-334-1504
  • Fax:
Mailing address:
  • Phone: 888-719-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JEFFREY KORNICK
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 330-867-7274