Provider Demographics
NPI:1427033745
Name:CAPITAL IMAGING,LTD
Entity Type:Organization
Organization Name:CAPITAL IMAGING,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/INVESTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-595-8867
Mailing Address - Street 1:3132 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1517
Mailing Address - Country:US
Mailing Address - Phone:614-784-8522
Mailing Address - Fax:614-784-8566
Practice Address - Street 1:3132 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1517
Practice Address - Country:US
Practice Address - Phone:614-784-8522
Practice Address - Fax:614-784-8566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2317077Medicaid
ID01251Medicare ID - Type Unspecified