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General NPI Number Information
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NPI Number | 1609825652
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Entity Type | Organization
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Legal Business Name | TRI STATE DIAGNOSTIC SERVICES , INC
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 08/19/2011
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Provider Practice Location Address
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Address Line | 2446 KIPLING AVE
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City | CINCINNATI
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State | OH
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Zip | 45239-6650
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Country | US
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Telephone | 513-853-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 932321
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City | CLEVELAND
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State | OH
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Zip | 44193-0001
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Country | US
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Telephone | 513-853-5000
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Fax |
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Authorized Official
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Title or Position | MD: AUTHORIZED SIGNATORY
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Name | JAMES KENNEALY
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Credential | MD
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Telephone | 513-451-1930
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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 |
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License Number State |
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