Provider Demographics
NPI:1730179821
Name:NORTHEASTERN HIGH-FIELD MRI, LLC
Entity type:Organization
Organization Name:NORTHEASTERN HIGH-FIELD MRI, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-281-3400
Mailing Address - Street 1:4790 RED BANK EXPY
Mailing Address - Street 2:SUITE 128
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-1598
Mailing Address - Country:US
Mailing Address - Phone:513-281-3400
Mailing Address - Fax:513-527-2275
Practice Address - Street 1:4900 PARKWAY DR
Practice Address - Street 2:SUITE 140
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8429
Practice Address - Country:US
Practice Address - Phone:513-459-2525
Practice Address - Fax:513-459-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0639IC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000351228OtherANTHEM PIN
OH2209158Medicaid
000000351228OtherANTHEM PIN