Provider Demographics
NPI:1700993417
Name:RADIOLOGY AND IMAGING SERVICES, INC
Entity type:Organization
Organization Name:RADIOLOGY AND IMAGING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-867-7274
Mailing Address - Street 1:PO BOX 931286
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-1494
Mailing Address - Country:US
Mailing Address - Phone:888-719-9012
Mailing Address - Fax:330-493-7123
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2433
Practice Address - Country:US
Practice Address - Phone:330-384-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000024853OtherANTHEM
OHCC3678OtherRAILROAD MC
OHCN1167OtherRAILROAD MC
OH0474606Medicaid
OHCF7408OtherRAILROAD MC
OH00000024853OtherANTHEM
OH9290071Medicare PIN