Basic Information
| Provider Information | |||||||||
| NPI: | 1336255066 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIOLOGY SERVICES OF OHIO, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21610 | ||||||||
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| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432210610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009237963 | ||||||||
| FaxNumber: | 6147712248 | ||||||||
| Practice Location | |||||||||
| Address1: | 615 FULTON ST | ||||||||
| Address2: | |||||||||
| City: | PORT CLINTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434522001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197343131 | ||||||||
| FaxNumber: | 6147712248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 10/06/2011 | ||||||||
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| AuthorizedOfficialLastName: | HAZNECI | ||||||||
| AuthorizedOfficialFirstName: | SINA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4197343131 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35-05-6761-H | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.