Provision Imaging of Lake County

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

PROVISION IMAGING OF LAKE COUNTY

Practice address

7511 Fredle Dr
Painesville, OH 44077-9406

Phone

(440) 354-3686

Fax

(440) 354-6708

NPI assigned

Jul 26, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Addresses

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": "1831113927",
    "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": "7511 FREDLE DR",
            "city": "PAINESVILLE",
            "state": "OH",
            "postal_code": "440779406",
            "telephone_number": "440-354-3686",
            "fax_number": "440-354-6708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISION IMAGING OF LAKE COUNTY",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Allen Posner, M.D.
• Beth A. Potulski, OTR/L
• John Price
• Julie Price
• Meghan Elizabeth Province, MOT, OTR/L
• Lusi Radan, M.A., CCC-SLP
• Jenna N Radcliffe, LPN
• Dianne Marie Rafferty, CRNP
• Deirdre Denine Raimey, CNP
• Karen Rattini, CRNA

• Radiology Clinic/Center in Painesville, OH
• Providers in Painesville, OH by specialty
• Radiology Clinic/Center in Ohio

• 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.