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General NPI Number Information
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NPI Number | 1841247566
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Entity Type | Organization
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Legal Business Name | CLINTON RADIOLOGY PSC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 610 W MAIN ST
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City | WILMINGTON
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State | OH
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Zip | 45177-2125
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Country | US
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Telephone | 937-382-9353
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Fax | 937-382-6633
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Provider Business Mailing Address
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Address Line | PO BOX 865
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City | WILMINGTON
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State | OH
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Zip | 45177-0865
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Country | US
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Telephone | 513-852-2451
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES P HAVEY
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Credential | MD
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Telephone | 937-382-9353
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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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