# CINCINNATI PET SCAN, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Northern KY PET Scan, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740224419
- **Authorized official:** JOHN MATTES (PRESIDENT)
- **Authorized official phone:** (513) 791-9959

## Contact information

- **Practice address:** 651 CENTRE VIEW BLVD, CRESVIEW HILLS, KY 41017
- **Practice address phone:** (859) 547-1240
- **Practice address fax:** (859) 547-1245
- **Mailing address:** 5053 WOOSTER RD, CINCINNATI, OH 45226-2326
- **Mailing address phone:** (513) 751-2145
- **Mailing address fax:** (513) 751-2138

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/15/2006
- **Last updated:** 11/22/2011