Organization
STADIUM OPEN MRI, LLC
Active
Organization
STADIUM OPEN MRI, LLC
Active
Other names
ProScan Imaging Paycor Stadium
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL ALEXANDER BARBER (DIRECTOR, RCM)
(513) 316-9385
Entity
Organization
Contact information
Practice address
6 PAYCOR STADIUM, CINCINNATI, OH 45202-3418
(513) 455-4999
(513) 455-4998
Mailing address
6 PAYCOR STADIUM, CINCINNATI, OH 45202-3418
(513) 455-4999
(513) 455-4998
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0677IC
OH
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000332753
ANTHEM PIN
OH
05
—
200473300A
—
IN
05
—
2228888
—
OH
05
—
86000585
—
KY
Enumeration date
10/28/2005
Last updated
05/30/2024
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