Basic Information
| Provider Information | |||||||||
| NPI: | 1467569285 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIOLOGY AND IMAGING SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 931286 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441931494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887199012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 659 BOULEVARD ST | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446222026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309962389 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 11/14/2007 | ||||||||
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| AuthorizedOfficialLastName: | KORNICK | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 3306747274 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | CF7408 | 01 | OH | RAILROAD MC | OTHER | CC3678 | 01 | OH | RAILROAD MC | OTHER | CN1167 | 01 | OH | RAILROAD MC | OTHER |