Organization
CINCINNATI PET SCAN, LLC
Active
Other names
Northern KY PET Scan, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MATTES (PRESIDENT)
(513) 791-9959
Entity
Organization
Contact information
Practice address
651 CENTRE VIEW BLVD, CRESVIEW HILLS, KY 41017
(859) 547-1240
(859) 547-1245
Mailing address
5053 WOOSTER RD, CINCINNATI, OH 45226-2326
(513) 751-2145
(513) 751-2138
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86000437
—
KY
Enumeration date
06/15/2006
Last updated
11/22/2011
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