Healthcare Provider Details

I. General information

NPI: 1366558942
Provider Name (Legal Business Name): SOUTH ZANESVILLE FAMILY MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MAYSVILLE AVE
ZANESVILLE OH
43701-6172
US

IV. Provider business mailing address

200 N MAYSVILLE AVE
ZANESVILLE OH
43701-6172
US

V. Phone/Fax

Practice location:
  • Phone: 740-455-3112
  • Fax: 740-454-3643
Mailing address:
  • Phone: 740-455-3112
  • Fax: 740-454-3643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34004852
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34003310
License Number StateOH

VIII. Authorized Official

Name: DR. RONALD J KALCHIK
Title or Position: PRESIDENT
Credential: D/O/
Phone: 740-455-3112