Provider Demographics
NPI:1366594657
Name:POLAND IMAGING
Entity type:Organization
Organization Name:POLAND IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MACGREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-605-1560
Mailing Address - Street 1:1413 GOLDEN GATE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6615 CLINGAN RD
Practice Address - Street 2:SUITE F
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-2196
Practice Address - Country:US
Practice Address - Phone:440-605-1560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPOID03281Medicare PIN