Provider Demographics
NPI:1871595066
Name:MOLECULAR IMAGING OF HAMILTON
Entity type:Organization
Organization Name:MOLECULAR IMAGING OF HAMILTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-526-0005
Mailing Address - Street 1:PO BOX 20347
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44701-0347
Mailing Address - Country:US
Mailing Address - Phone:330-491-1490
Mailing Address - Fax:330-491-1466
Practice Address - Street 1:4197 FULTON DR NW
Practice Address - Street 2:SUITE C
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2819
Practice Address - Country:US
Practice Address - Phone:330-491-1490
Practice Address - Fax:330-491-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0827IC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHID01221Medicare PIN