1841298734 NPI number — OHIO IMAGING LLC

Table of content: (NPI 1841298734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841298734 NPI number — OHIO IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OHIO IMAGING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841298734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1065 DELAWARE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-223-3456
Provider Business Mailing Address Fax Number:
740-223-3457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1065 DELAWARE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-223-3456
Provider Business Practice Location Address Fax Number:
740-223-3456
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
740-223-3456

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  0646IL , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1601432 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000173737 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 470000972 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7753161 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000384241 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2213198 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 954458478006 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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