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NPI Code Detail

MEDICARE: HOCKING VALLEY IMAGING, LLC

MEDICARE: HOCKING VALLEY IMAGING, LLC
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
1261QM1200XMagnetic Resonance Imaging (MRI) Clinic/Center1071ICOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548269103
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOCKING VALLEY IMAGING, LLC
Provider Business Mailing Address
First Line : 31500 CHIEFTAIN DR
Second Line : STE B
City : LOGAN
State : OH
Zip : 43138-8421
Country : US
Telephone Number : 740-380-6665
Fax Number : 740-380-6635
Provider Business Practice Location Address
First Line : 31500 CHIEFTAIN DR
Second Line : STE B
City : LOGAN
State : OH
Zip : 43138-8421
Country : US
Telephone Number : 740-380-6665
Fax Number : 740-380-6635
Authorized Official
Title or Position : PRESIDENT
Name : DR. ROY BONTRAGER
Credential : M.D.
Telephone Number : 740-380-6665
Provider Enumeration Date : 07/18/2005
Last Update Date : 08/22/2020

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Directions to “HOCKING VALLEY IMAGING, LLC ” Practice Location

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