Progressive Wellness Imaging

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

IOG1038601 Issued in OH

Legal business name

PROGRESSIVE WELLNESS IMAGING

Practice address

7640 Sylvania Ave
Suite a-1
Sylvania, OH 43560-9729

Phone

(419) 517-1700

Fax

(417) 517-1711

NPI assigned

Oct 20, 2006

Last updated

Oct 15, 2007By the provider in NPPES

Organization subpart

Yes

Parent organization

PHYSICIANS IMAGING SOLUTIONS IIAs reported in NPPES

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

Authorized official

Name

Mrs. Diane S Moreno

Title

General Manager

Phone

(419) 517-1700

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1912080441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7640 SYLVANIA AVE",
            "address_2": "SUITE A-1",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435609729",
            "telephone_number": "419-517-1700",
            "fax_number": "417-517-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7640 SYLVANIA AVE",
            "address_2": "SUITE A-1",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435609729",
            "telephone_number": "419-517-1700",
            "fax_number": "417-517-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE WELLNESS IMAGING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHYSICIANS IMAGING SOLUTIONS II",
        "enumeration_date": "2006-10-20",
        "last_updated": "2007-10-15",
        "status": "A",
        "authorized_official_last_name": "MORENO",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "419-517-1700",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "OH",
            "license": "IOG1038601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00361454",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2614648",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH CARE FACILITY LIC",
            "identifier": "1187-IC",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Radiology Clinic/Center in Sylvania, OH
• Providers in Sylvania, 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 Oct 15, 2007; 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.