Organization
PROVIDENCE MEDICAL GROUP, INC.
Active
Organization
PROVIDENCE MEDICAL GROUP, INC.
Active
Other names
PMG Vascular Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN J. BECKER (CHIEF OPERATING OFFICER)
(937) 297-8999
Entity
Organization
Contact information
Practice address
2912 SPRINGBORO RD, SUITE 201, MORAINE, OH 45439-1674
(937) 396-8137
(937) 297-4868
Mailing address
2912 SPRINGBORO RD, SUITE 201, MORAINE, OH 45439-1674
(937) 297-8999
(937) 298-9673
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2380294
—
OH
Enumeration date
04/26/2016
Last updated
04/26/2016
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