Provider Demographics
NPI:1417970542
Name:X-RAY, INC.
Entity Type:Organization
Organization Name:X-RAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-303-6805
Mailing Address - Street 1:967 BELLEFONTAINE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2888
Mailing Address - Country:US
Mailing Address - Phone:419-225-6346
Mailing Address - Fax:419-225-6609
Practice Address - Street 1:1001 BELLEFONTAINE AVE
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2800
Practice Address - Country:US
Practice Address - Phone:419-226-5055
Practice Address - Fax:419-226-5064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000024953OtherANTHEM
OH0517686Medicaid
OH2212411Medicaid
CF7375OtherRAILROAD MEDICARE
OH2212411Medicaid
OH=========020OtherMEDICAL MUTUAL
CF7375OtherRAILROAD MEDICARE
OH=========00OtherOH BUREAU OF WORK COMP
OH=========007OtherMEDICAL MUTUAL
OH000000024953OtherANTHEM
OH9917513Medicare ID - Type Unspecified