| Organization Name: | CINCINNATI PET SCAN, LLC |
| NPI Number: | 1023195088 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN MATTES (PRESIDENT) |
| Mailing Address: | 651 Centre View Blvd 110 Crestview Hills |
| State: | KY US |
| Postal Code: | 410175423 |
| Phone Number: | 8595471240 |
| Fax Number: | 8595471245 |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0200X |
| License Number: | 730088 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology |
| Taxonomy Definition: | |