Healthcare Provider Details

I. General information

NPI: 1841298734
Provider Name (Legal Business Name): OHIO IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 DELAWARE AVE
MARION OH
43302
US

IV. Provider business mailing address

1065 DELAWARE AVE
MARION OH
43302
US

V. Phone/Fax

Practice location:
  • Phone: 740-223-3456
  • Fax: 740-223-3456
Mailing address:
  • Phone: 740-223-3456
  • Fax: 740-223-3457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0646IL
License Number StateOH

VIII. Authorized Official

Name: MRS. DEBRA JO MYERS
Title or Position: ADMINISTRATOR
Credential:
Phone: 740-223-3456