MEDICARE: KNOX DIAGNOSTIC 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
1	174400000X	Specialist

Other Identifiers

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

General Provider Information

NPI Number	:	1639175540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNOX DIAGNOSTIC IMAGING LLC

Provider Business Mailing Address
First Line	:	1330 COSHOCTON AVE
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050
Country	:	US
Telephone Number	:	740-393-9100
Fax Number	:	740-393-9804

Provider Business Practice Location Address
First Line	:	1330 COSHOCTON AVE
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050
Country	:	US
Telephone Number	:	740-393-9100
Fax Number	:	740-393-9804

Authorized Official
Title or Position	:	BOARD MEMBER
Name	:	UNGE KRAJENSKI
Credential	:
Telephone Number	:	740-392-9881

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	11/26/2013

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Directions to “KNOX DIAGNOSTIC IMAGING LLC ” Practice Location

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