Provider Demographics
NPI:1609845064
Name:WEST OHIO X-RAY
Entity Type:Organization
Organization Name:WEST OHIO X-RAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEETARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-238-2390
Mailing Address - Street 1:PO BOX 5156
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-5156
Mailing Address - Country:US
Mailing Address - Phone:419-224-5707
Mailing Address - Fax:419-229-0040
Practice Address - Street 1:200 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2400
Practice Address - Country:US
Practice Address - Phone:419-394-3335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
027970300OtherFEDERAL BLACK LUNG PROG
OHCA0584OtherRAILROAD MEDICARE
OH0610217Medicaid
127859300OtherDEPT OF LABOR - (FECA)
OH000000026829OtherANTHEM BCBS
OH=========011OtherMEDICAL MUTUAL OF OHIO
OH=========020OtherMEDICAL MUTUAL OF OH
OH=========-01OtherBUREAU OF WORKERS COMP
OH0610217Medicaid
OH=========011OtherMEDICAL MUTUAL OF OHIO