Organization
NORTHERN LIGHTS IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RUTH N WALLACE (AUTHORIZED OFFICIAL)
(513) 281-3400
Entity
Organization
Contact information
Practice address
3287 MAPLE AVE, ZANESVILLE, OH 43701-1312
(740) 450-4200
(740) 450-1785
Mailing address
3287 MAPLE AVE, ZANESVILLE, OH 43701-1312
(740) 450-4200
(740) 450-1785
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
1274IC
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2735302
—
OH
Enumeration date
11/21/2006
Last updated
09/04/2007
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