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General NPI Number Information
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NPI Number | 1669472452
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Entity Type | Organization
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Legal Business Name | SOUTHERN OHIO RADIOLOGISTS INC
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 1805 27TH ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2640
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Country | US
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Telephone | 740-354-5000
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Fax |
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Provider Business Mailing Address
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Address Line | L-2603 PO BOX 600001
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City | COLUMBUS
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State | OH
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Zip | 43260-0001
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Country | US
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Telephone | 866-871-7822
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT LOGAN
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Credential | MD
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Telephone | 740-354-5000
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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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