=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124144878
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOUNGSTOWN ASSOCIATES IN RADIOLOGY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 03/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7250 WEST BLVD
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44512-4346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-758-8353
-----------------------------------------------------
Fax | 330-758-0369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7250 WEST BLVD
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44512-4346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-758-8353
-----------------------------------------------------
Fax | 330-758-0369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | JUDITH MILES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-758-8353
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 0116IC
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------