Organization
CLINTON RADIOLOGY PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES P HAVEY MD (PRESIDENT)
(937) 382-9353
Entity
Organization
Contact information
Practice address
610 W MAIN ST, WILMINGTON, OH 45177-2125
(937) 382-9353
(937) 382-6633
Mailing address
PO BOX 865, WILMINGTON, OH 45177-0865
(513) 852-2451
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000004057
ANTHEM
—
05
—
0455225
—
OH
01
—
CF4981
MEDICARE RAILROAD
—
Enumeration date
05/28/2006
Last updated
04/20/2008
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