Organization
CINCINNATI PET SCAN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN MATTES (PRESIDENT)
(513) 791-9959
Entity
Organization
Contact information
Practice address
651 CENTRE VIEW BLVD, 110, CRESTVIEW HILLS, KY 41017-5423
(859) 547-1240
(859) 547-1245
Mailing address
651 CENTRE VIEW BLVD, 110, CRESTVIEW HILLS, KY 41017-5423
(859) 547-1240
(859) 547-1245
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
730088
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86000437
—
KY
Enumeration date
11/01/2006
Last updated
08/22/2020
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