| NPI | 1588364392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN VAUGHN VP, Provider Enrollment 330-309-6984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2025-08-06 |