Organization
PROSCAN RADIOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH N WALLACE (CFO)
(513) 281-3400
Entity
Organization
Contact information
Practice address
5400 KENNEDY AVE, CINCINNATI, OH 45213-2664
(513) 281-3400
(513) 527-2275
Mailing address
5400 KENNEDY AVE, CINCINNATI, OH 45213-2664
(513) 281-3400
(513) 527-2275
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0027626
—
NJ
05
—
03733011
—
MS
05
—
1008658800001
—
PA
05
—
20002178
—
NH
05
—
2552956
—
OH
01
—
298152
AMERIGROUP
—
05
—
3810007868
—
WV
05
—
4401045
—
TN
05
—
65940819
—
KY
05
—
7136252
—
WA
05
—
954728
—
AZ
05
—
QPB842
—
SC
Enumeration date
10/28/2005
Last updated
11/13/2007
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