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General NPI Number Information
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NPI Number | 1972593093
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Entity Type | Organization
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Legal Business Name | PROSCAN TYLERSVILLE, LLC
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 7003 LOOMIS LN
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City | LIBERTY TOWNSHIP
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State | OH
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Zip | 45069-3898
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Country | US
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Telephone | 513-759-7350
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Fax | 513-759-7351
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Provider Business Mailing Address
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Address Line | 7003 LOOMIS LN
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City | LIBERTY TOWNSHIP
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State | OH
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Zip | 45069-3898
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Country | US
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Telephone | 513-759-7350
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Fax | 513-759-7351
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Authorized Official
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Title or Position | COO
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Name | KAREN AMAYA
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Credential |
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Telephone | 513-281-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0868IC
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License Number State | OH
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