MEDICARE: SOUTH ZANESVILLE FAMILY MEDICAL CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34004852	OH
2	207Q00000X	Family Medicine Physician	34003310	OH

General Provider Information

NPI Number	:	1366558942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH ZANESVILLE FAMILY MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	200 N MAYSVILLE AVE
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-6172
Country	:	US
Telephone Number	:	740-455-3112
Fax Number	:	740-454-3643

Provider Business Practice Location Address
First Line	:	200 N MAYSVILLE AVE
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-6172
Country	:	US
Telephone Number	:	740-455-3112
Fax Number	:	740-454-3643

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD J KALCHIK
Credential	:	D/O/
Telephone Number	:	740-455-3112

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	08/22/2020

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