Provider Demographics
NPI:1881695575
Name:REGIONAL DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:REGIONAL DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-468-6012
Mailing Address - Street 1:4400 RENAISSANCE PKWY.
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44128
Mailing Address - Country:US
Mailing Address - Phone:216-464-8484
Mailing Address - Fax:216-468-6021
Practice Address - Street 1:25580 AURORA RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-2524
Practice Address - Country:US
Practice Address - Phone:440-786-1900
Practice Address - Fax:440-786-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10621C2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2238760Medicaid
OH2238760Medicaid
OH2238760Medicaid