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General NPI Number Information
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NPI Number | 1023195088
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Entity Type | Organization
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Legal Business Name | CINCINNATI PET SCAN, LLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 651 CENTRE VIEW BLVD 110
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017-5423
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Country | US
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Telephone | 859-547-1240
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Fax | 859-547-1245
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Provider Business Mailing Address
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Address Line | 651 CENTRE VIEW BLVD 110
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017-5423
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Country | US
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Telephone | 859-547-1240
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Fax | 859-547-1245
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN MATTES
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Credential |
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Telephone | 513-791-9959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 730088
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License Number State | KY
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