Provider Demographics
NPI:1639175540
Name:KNOX DIAGNOSTIC IMAGING LLC
Entity Type:Organization
Organization Name:KNOX DIAGNOSTIC IMAGING LLC
Other - Org Name:KNOX DIAGNOSTIC IMAGING CENTER LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:UNGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAJENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-392-9881
Mailing Address - Street 1:1330 COSHOCTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050
Mailing Address - Country:US
Mailing Address - Phone:740-393-9100
Mailing Address - Fax:740-393-9804
Practice Address - Street 1:1330 COSHOCTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-393-9100
Practice Address - Fax:740-393-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2547800Medicaid
OHID02311Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER