MEDICARE: OHIO DIAGNOSTIC IMAGING INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085N0904X	Nuclear Radiology Physician

General Provider Information

NPI Number	:	1003090994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO DIAGNOSTIC IMAGING INC.

Provider Business Mailing Address
First Line	:	PO BOX 24036
Second Line	:
City	:	PEPPER PIKE
State	:	OH
Zip	:	44124-0036
Country	:	US
Telephone Number	:	866-494-8260
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 LYMAN CIR
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-2110
Country	:	US
Telephone Number	:	216-403-6515
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES O'DONNELL
Credential	:	MD
Telephone Number	:	216-403-6515

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	01/29/2008

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