Provider Demographics
NPI:1326128018
Name:CHILLICOTHE RADIOLOGY INC
Entity Type:Organization
Organization Name:CHILLICOTHE RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-774-1111
Mailing Address - Street 1:PO BOX 1610
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-5610
Mailing Address - Country:US
Mailing Address - Phone:740-774-1111
Mailing Address - Fax:740-774-4074
Practice Address - Street 1:47 N PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1760
Practice Address - Country:US
Practice Address - Phone:740-774-1111
Practice Address - Fax:740-774-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000006061OtherANTHEM BC/BS
OH0270791Medicaid
CG0066OtherRAILROAD MEDICARE
000000006061OtherANTHEM BC/BS-FEDERAL
000000006061OtherANTHEM BC/BS-FEDERAL
OH0270791Medicaid
CG0066OtherRAILROAD MEDICARE