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General NPI Number Information
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NPI Number | 1033160197
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Entity Type | Organization
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Legal Business Name | SUBURBAN RADIOLOGY LIMI
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 10655 WASHINGTONVILLE RD
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City | CANFIELD
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State | OH
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Zip | 44406-9448
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Country | US
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Telephone | 330-726-6010
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Fax | 330-726-6017
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Provider Business Mailing Address
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Address Line | PO BOX 14280
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City | YOUNGSTOWN
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State | OH
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Zip | 44514-7280
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Country | US
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Telephone | 330-726-6010
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Fax | 330-726-6017
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Authorized Official
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Title or Position | OWNER
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Name | ADAM G CROUCH
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Credential | DO
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Telephone | 330-726-6010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 34006305C
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License Number State | OH
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