Healthcare Provider Details

I. General information

NPI: 1629711270
Provider Name (Legal Business Name): KRM IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9387 S OLD STATE RD
LEWIS CENTER OH
43035-8448
US

IV. Provider business mailing address

9387 S OLD STATE RD
LEWIS CENTER OH
43035-8448
US

V. Phone/Fax

Practice location:
  • Phone: 614-785-9334
  • Fax: 614-785-9375
Mailing address:
  • Phone: 614-785-9334
  • Fax: 614-785-9375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN TIDWELL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 614-785-9334