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General NPI Number Information
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NPI Number | 1104420645
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Entity Type | Organization
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Legal Business Name | CINCINNATI IMAGING CENTER LLC
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 644 EDEN PARK DR
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City | CINCINNATI
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State | OH
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Zip | 45202-6031
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Country | US
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Telephone | 513-572-8670
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Fax |
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Provider Business Mailing Address
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Address Line | 644 EDEN PARK DR
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City | CINCINNATI
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State | OH
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Zip | 45202-6031
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Country | US
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Telephone | 513-572-8670
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Fax |
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Authorized Official
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Title or Position | INTERIM EXECUTIVE DIRECTOR/DON
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Name | JENNIFER WALDROFF
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Credential | RN
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Telephone | 513-572-8670
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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 |
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License Number State |
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