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General NPI Number Information
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NPI Number | 1477731073
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Entity Type | Organization
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Legal Business Name | ST ELIZABETH SOUTHWOODS IMAGING LLC
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 250 DEBARTOLO PL BLDG B
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-7004
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Country | US
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Telephone | 330-726-2595
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Fax | 330-726-3249
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Provider Business Mailing Address
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Address Line | 250 DEBARTOLO PL BLDG B
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-7004
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Country | US
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Telephone | 330-726-2595
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Fax | 330-726-3249
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Authorized Official
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Title or Position | TREASURER
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Name | MR. JAMES E FULCINITI
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Credential | CPA
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Telephone | 330-729-0357
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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 | 0056IC
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License Number State | OH
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