Provider Demographics
NPI:1144279613
Name:TRUMBULL RADIOLOGISTS INC
Entity type:Organization
Organization Name:TRUMBULL RADIOLOGISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOGES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:330-841-5807
Mailing Address - Street 1:9360 RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:MARCY
Mailing Address - State:NY
Mailing Address - Zip Code:13403-2070
Mailing Address - Country:US
Mailing Address - Phone:877-698-1700
Mailing Address - Fax:330-841-5858
Practice Address - Street 1:TRUMBULL RADIOLOGISTS INC
Practice Address - Street 2:2588 STATE ROUTE 5
Practice Address - City:COURTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9653
Practice Address - Country:US
Practice Address - Phone:330-841-5807
Practice Address - Fax:330-841-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0043303Medicaid
OH0043303Medicaid