Healthcare Provider Details

I. General information

NPI: 1962438549
Provider Name (Legal Business Name): IMAGE INTERPRETATION SERVICES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 VALLEY RD
MINGO JCT OH
43938-1463
US

IV. Provider business mailing address

PO BOX 76648
CLEVELAND OH
44101-6500
US

V. Phone/Fax

Practice location:
  • Phone: 740-266-4908
  • Fax: 740-264-4376
Mailing address:
  • Phone: 740-266-4908
  • Fax: 740-264-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOH350780001B
License Number StateOH

VIII. Authorized Official

Name: DR. JOHN FRANK BALZANO
Title or Position: OWNER
Credential: MD
Phone: 740-266-4908