# KING'S MEDICAL IMAGING AT WATERMARK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043213077
- **Authorized official:** MS. V. RENAE COYNE (DIRECTOR OF BILLING)
- **Authorized official phone:** (330) 653-3968

## Contact information

- **Practice address:** 1680 WATERMARK DR, STE 101, COLUMBUS, OH 43215-1034
- **Practice address phone:** (614) 485-1804
- **Practice address fax:** (614) 485-1321
- **Mailing address:** 1894 GEORGETOWN RD, HUDSON, OH 44236-4058
- **Mailing address phone:** (330) 653-3968
- **Mailing address fax:** (330) 656-1660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 293D00000X | Physiological Laboratory | — | NULL | Yes |

## Other

- **Enumeration date:** 05/23/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2320698 | — | OH |