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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