=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225343510
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AHS OHIO DIAGNOSTICS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2010
-----------------------------------------------------
Last Update Date | 08/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 OHLTOWN RD SUITE 103
-----------------------------------------------------
City | AUSTINTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44515-2331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-884-1530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 BURTON HILLS BLVD SUITE 250
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37215-6293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR VP AND SECRETARY
-----------------------------------------------------
Name | STEPHEN PETROVICH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-296-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------