STEEL VALLEY DIVERSIFIED, INC (STEEL VALLEY PORTABLE X-RAY) - NPI NUMBER 1508890591

Summary

Provider Name: STEEL VALLEY DIVERSIFIED, INC (STEEL VALLEY PORTABLE X-RAY)

NPI Number: 1508890591

Clasification: Clinic/Center (261QR0208X)

Specialization: Radiology, Mobile

Address:
5136 TUSCARAWAS ST W
CANTON, OH
ZIP 44708

Phone Number: (330) 479-1908



Detailed Information

STEEL VALLEY DIVERSIFIED, INC is a radiology, mobile clinic/center in Canton, OH. The assigned NPI number for this provider is 1508890591 and is registered as an organization entity type.
The provider Is Doing Business As Steel Valley Portable X-ray.

The provider's business address is:

5136 TUSCARAWAS ST W
CANTON, OH
ZIP 44708-016
Phone: (330) 479-1908
Fax: (330) 479-1933

The provider's authorized official is Terry Lynn Ray .
The authorized official title is President and has the following contact phone number (330) 479-1908.

The enumeration date for this NPI number is 7/10/2006 and was last updated on 7/8/2007.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QR0208X Clinic/Center Radiology, Mobile Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 3698641 MEDICARE ID-TYPE UNSPECIFIED OH
2 2215490 MEDICAID OH

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1508890591 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name STEEL VALLEY DIVERSIFIED, INC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name STEEL VALLEY PORTABLE X-RAY Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 5136 TUSCARAWAS ST W The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name CANTON The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name OH The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 447085016 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 3304791908 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 3304791933 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 7/10/2006 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 7/8/2007 The date that a record was last updated or changed.
16 Authorized Official Last Name RAY The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name TERRY The first name of the authorized official.
18 Authorized Official Middle Name LYNN The middle name of the authorized official.
19 Authorized Official Title or Position PRESIDENT The title or position of the authorized official.
20 Authorized Official Telephone Number 3304791908 The 10-position telephone number of the authorized official.
21 Healthcare Provider Taxonomy Code 1 261QR0208X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 3698641 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier Type Code 1 04 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier State 1 OH
26 Other Provider Identifier 2 2215490 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier Type Code 2 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier State 2 OH
29 Authorized Official Name Prefix Text MRS.

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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