=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326110206
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH CENTRAL OHIO RADIOLOGY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 651 W MARION RD
-----------------------------------------------------
City | MOUNT GILEAD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43338-1027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-946-6841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8038
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43201-0038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-294-5481
-----------------------------------------------------
Fax | 614-294-7388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EVP
-----------------------------------------------------
Name | MR. BARRY F HOOD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-851-8089
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 1659426
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------