NPIMap

Organization Active NPI

Cincinnati Pet Scan, LLC

Doing business as Northern KY PET Scan, LLC

  • Radiology Clinic/Center
  • Cresview Hills, KY
National Provider Identifier
1740224419
Registry record updated Nov 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
CINCINNATI PET SCAN, LLC
Doing business as
Northern KY PET Scan, LLC
Practice address
651 Centre View Blvd
Cresview Hills, KY 41017
Phone
(859) 547-1240
Fax
(859) 547-1245
NPI assigned
Jun 15, 2006
Last updated
Nov 22, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2011

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

Authorized official

Name
John Mattes
Title
President
Phone
(513) 791-9959

Specialties & licenses 1

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

Addresses

Primary practice location

651 Centre View Blvd
Cresview Hills, KY 41017

Mailing address

5053 Wooster Rd
Cincinnati, OH 45226-2326
Phone (513) 751-2145

Other identifiers 1

IdentifierTypeStateIssuer
86000437MedicaidKY

Other names 1

  • Northern KY PET Scan, LLC Doing business as

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321920000000",
    "number": "1740224419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5053 WOOSTER RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452262326",
            "telephone_number": "513-751-2145",
            "fax_number": "513-751-2138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 CENTRE VIEW BLVD",
            "city": "CRESVIEW HILLS",
            "state": "KY",
            "postal_code": "41017",
            "telephone_number": "859-547-1240",
            "fax_number": "859-547-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CINCINNATI PET SCAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2011-11-22",
        "status": "A",
        "authorized_official_last_name": "MATTES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "513-791-9959"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "86000437",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern KY PET Scan, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; 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.