NPIMap

Organization Active NPI

Provision Imaging of Northeast Ohio

  • Radiology Clinic/Center
  • Lyndhurst, OH
National Provider Identifier
1346264439
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
1090IC Issued in OH
Legal business name
PROVISION IMAGING OF NORTHEAST OHIO
Practice address
29001 Cedar Rd
Suite 104
Lyndhurst, OH 44124-4062
Phone
(440) 449-2001
Fax
(409) 449-2002
NPI assigned
Jul 26, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Matt Trent
Title
Coo
Phone
(405) 842-7768

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X 1090IC OH Primary

Addresses

Primary practice location

29001 Cedar Rd
Suite 104
Lyndhurst, OH 44124-4062

Mailing address

1601 NW Expressway
Suite 1300
Oklahoma City, OK 73118
Phone (405) 842-7768

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346264439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 NW EXPRESSWAY",
            "address_2": "SUITE 1300",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73118",
            "telephone_number": "405-842-7768",
            "fax_number": "405-842-7789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29001 CEDAR RD",
            "address_2": "SUITE 104",
            "city": "LYNDHURST",
            "state": "OH",
            "postal_code": "441244062",
            "telephone_number": "440-449-2001",
            "fax_number": "409-449-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISION IMAGING OF NORTHEAST OHIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TRENT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "MATT",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "405-842-7768"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "OH",
            "license": "1090IC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lyndhurst, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.