Provider Demographics
NPI:1689854705
Name:1080 INVESTMENTS, LLC
Entity type:Organization
Organization Name:1080 INVESTMENTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GANOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-557-6165
Mailing Address - Street 1:2612 NEEDMORE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-4206
Mailing Address - Country:US
Mailing Address - Phone:317-557-6165
Mailing Address - Fax:
Practice Address - Street 1:2612 NEEDMORE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-4206
Practice Address - Country:US
Practice Address - Phone:317-557-6165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06M113001335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier