MEDICARE: GLENWAY IMAGING 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	174400000X	Specialist

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942201926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENWAY IMAGING LLC

Provider Business Mailing Address
First Line	:	PO BOX 42471
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-0471
Country	:	US
Telephone Number	:	513-965-8041
Fax Number	:	513-965-8091

Provider Business Practice Location Address
First Line	:	6350 GLENWAY AVE
Second Line	:	STE 102
City	:	CINCINNATI
State	:	OH
Zip	:	45211-6378
Country	:	US
Telephone Number	:	513-965-8041
Fax Number	:	513-965-8091

Authorized Official
Title or Position	:	CLIENT SERVICES MANAGER
Name	:	LYNN GRAY
Credential	:
Telephone Number	:	513-965-8041

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	02/21/2008

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Directions to “GLENWAY IMAGING LLC ” Practice Location

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