Organization
FAIRFIELD DIAGNOSTIC IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ANTAL (PRACTICE / BUSINESS MANAGER)
(740) 654-6312
Entity
Organization
Contact information
Practice address
1241 RIVER VALLEY BLVD, LANCASTER, OH 43130-1653
(740) 654-6312
Mailing address
PO BOX 1523, LIMA, OH 45802-1523
(419) 224-5707
(419) 229-0040
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000162681
ANTHEM BCBS
OH
01
—
124621800
DEPT OF LABOR--FECA
—
05
—
2064779
—
OH
01
—
CI3266
RAILROAD MEDICARE
OH
Enumeration date
03/24/2006
Last updated
07/07/2011
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