Basic Information
| Provider Information | |||||||||
| NPI: | 1538133293 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE RADIOLOGY OF OHIO INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1066 | ||||||||
| Address2: | 501 N MAIN ST | ||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194224058 | ||||||||
| FaxNumber: | 4194240553 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 W WALLACE ST | ||||||||
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| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458401239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194235429 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VALENTZ | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4194295429 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 2461670 | 05 | OH | MEDICAID | 000000324315 | 01 | OH | ANTHEM | OTHER |