Provider Demographics
NPI:1376574699
Name:BIG RUN IMAGING CENTER LLC
Entity Type:Organization
Organization Name:BIG RUN IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AMB SVCS,IMAGING BOARD PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-546-4303
Mailing Address - Street 1:4300 CLIME RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-6491
Mailing Address - Country:US
Mailing Address - Phone:614-279-4925
Mailing Address - Fax:614-279-4958
Practice Address - Street 1:4300 CLIME RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-6491
Practice Address - Country:US
Practice Address - Phone:614-279-4925
Practice Address - Fax:614-279-4958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0453IC261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2098500Medicaid
OHBIID00011Medicare ID - Type Unspecified