MEDICARE: REGIONAL DIAGNOSTICS, 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	2085R0202X	Diagnostic Radiology Physician	10621C	OH

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	:	1881695575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	4400 RENAISSANCE PKWY.
Second Line	:
City	:	WARRENSVILLE HTS.
State	:	OH
Zip	:	44128
Country	:	US
Telephone Number	:	216-464-8484
Fax Number	:	216-468-6021

Provider Business Practice Location Address
First Line	:	25580 AURORA RD
Second Line	:
City	:	BEDFORD HTS
State	:	OH
Zip	:	44146-2524
Country	:	US
Telephone Number	:	440-786-1900
Fax Number	:	440-786-1931

Authorized Official
Title or Position	:	DIRECTOR OF MANAGED CARE
Name	:	CHRISTINE E. BOETTLER
Credential	:
Telephone Number	:	216-468-6012

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	08/22/2020

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