Provider Demographics
NPI:1275585465
Name:SARAJEAN SHALOSKY DBA BEDSIDE XRAY & EKG SERVICE
Entity Type:Organization
Organization Name:SARAJEAN SHALOSKY DBA BEDSIDE XRAY & EKG SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAJEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:800-922-1270
Mailing Address - Street 1:PO BOX 79
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-0079
Mailing Address - Country:US
Mailing Address - Phone:800-922-1270
Mailing Address - Fax:614-861-1180
Practice Address - Street 1:2198 WILLOW GLEN DR NW
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-9717
Practice Address - Country:US
Practice Address - Phone:800-922-1270
Practice Address - Fax:614-861-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHR2534598335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0789508Medicaid
OH0789508Medicaid