MEDICARE: MANSFIELD IMAGING CENTER LLC

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	261QR0200X	Radiology Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00070031	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821141102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANSFIELD IMAGING CENTER LLC

Provider Business Mailing Address
First Line	:	536 S TRIMBLE RD
Second Line	:	SUITE A
City	:	MANSFIELD
State	:	OH
Zip	:	44906-3418
Country	:	US
Telephone Number	:	419-774-9729
Fax Number	:	419-774-0006

Provider Business Practice Location Address
First Line	:	536 S TRIMBLE RD
Second Line	:	SUITE A
City	:	MANSFIELD
State	:	OH
Zip	:	44906-3418
Country	:	US
Telephone Number	:	419-774-9729
Fax Number	:	419-774-0006

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MR. JOHN COX
Credential	:
Telephone Number	:	419-522-3400

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	04/24/2008

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Directions to “MANSFIELD IMAGING CENTER LLC ” Practice Location

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