Source Diagnostics LLC

Primary specialty

Radiologic TechnologistTaxonomy code 247100000X

License

OH03645 Issued in OH

Legal business name

SOURCE DIAGNOSTICS LLC

Practice address

5275 Naiman Pkwy
Ste E
Solon, OH 44139-1029

Phone

(440) 542-1515

Fax

(440) 542-9482

NPI assigned

May 22, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Keith C Marchand

Title

President

Phone

(440) 645-4626

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331164800000",
    "number": "1386698470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5275 NAIMAN PKWY",
            "address_2": "STE E",
            "city": "SOLON",
            "state": "OH",
            "postal_code": "441391029",
            "telephone_number": "440-645-7822",
            "fax_number": "440-542-9482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5275 NAIMAN PKWY",
            "address_2": "STE E",
            "city": "SOLON",
            "state": "OH",
            "postal_code": "441391029",
            "telephone_number": "440-542-1515",
            "fax_number": "440-542-9482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2012-03-08",
        "status": "A",
        "authorized_official_last_name": "MARCHAND",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "440-645-4626",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "246W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "247100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist",
            "state": "OH",
            "license": "OH03645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2538052",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Solon Smiles - Dr. Michael S. Jack, DDS, LLC
• Karen Solonche, LPC
• Gabriel Somarriba, PSYD
• Steven B Sorin, MD
• Brittany Sorn, CCC-SLP
• Savina Sparker
• Katherine Spilker, PHARMD, RPH
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• Tira Stebbins, PH.D.

• Radiologic Technologist in Solon, OH
• Providers in Solon, OH by specialty
• Radiologic Technologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; 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.