Provider Demographics
NPI:1780927723
Name:BMX IMAGING CENTER, LLC
Entity type:Organization
Organization Name:BMX IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAYBALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-387-7200
Mailing Address - Street 1:1167 INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6360
Mailing Address - Country:US
Mailing Address - Phone:740-387-7200
Mailing Address - Fax:740-387-5728
Practice Address - Street 1:1069 DELAWARE AVE
Practice Address - Street 2:SUITE 104B
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-1400
Practice Address - Country:US
Practice Address - Phone:740-387-7200
Practice Address - Fax:740-387-5728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology