Provider Demographics
NPI:1841298734
Name:OHIO IMAGING LLC
Entity type:Organization
Organization Name:OHIO IMAGING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-223-3456
Mailing Address - Street 1:1065 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302
Mailing Address - Country:US
Mailing Address - Phone:740-223-3456
Mailing Address - Fax:740-223-3457
Practice Address - Street 1:1065 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302
Practice Address - Country:US
Practice Address - Phone:740-223-3456
Practice Address - Fax:740-223-3456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0646IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1601432OtherUNITED HEALTHCARE
OH000000173737OtherANTHEM BC/BS
OH470000972OtherRAILROAD MEDICARE
OH7753161OtherAETNA
OH000000384241OtherANTHEM
OH2213198Medicaid
OH954458478006OtherMEDICAL MUTUAL
OH=========002OtherMEDICAL MUTUAL
OH2213198Medicaid