Provider Demographics
NPI:1861519993
Name:SHARED MEDICAL IMAGING INC
Entity type:Organization
Organization Name:SHARED MEDICAL IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-469-9985
Mailing Address - Street 1:405 NILES CORTLAND RD SE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2460
Mailing Address - Country:US
Mailing Address - Phone:330-469-9985
Mailing Address - Fax:
Practice Address - Street 1:405 NILES CORTLAND RD SE
Practice Address - Street 2:SUITE 102
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2460
Practice Address - Country:US
Practice Address - Phone:330-469-9985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH200612500122247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty