Healthcare Provider Details

I. General information

NPI: 1093189482
Provider Name (Legal Business Name): ATHENS XRAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 E STATE ST SUITE 102
ATHENS OH
45701-2116
US

IV. Provider business mailing address

809 FARSON ST SUITE 105
BELPRE OH
45714-1066
US

V. Phone/Fax

Practice location:
  • Phone: 740-707-5319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SIMON HARGUS
Title or Position: OWNER
Credential:
Phone: 740-423-1507