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General NPI Number Information
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NPI Number | 1780927723
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Entity Type | Organization
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Legal Business Name | BMX IMAGING CENTER, LLC
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 1069 DELAWARE AVE SUITE 104B
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City | MARION
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State | OH
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Zip | 43302-1400
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Country | US
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Telephone | 740-387-7200
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Fax | 740-387-5728
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Provider Business Mailing Address
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Address Line | 1167 INDEPENDENCE AVE SUITE 100
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City | MARION
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State | OH
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Zip | 43302-6360
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Country | US
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Telephone | 740-387-7200
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Fax | 740-387-5728
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JAYBALAN MOODLEY
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Credential | M.D.
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Telephone | 740-387-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State |
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