Organization
PROSCAN IMAGING OF CHILLICOTHE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH N WALLACE (CFO)
(513) 281-3400
Entity
Organization
Contact information
Practice address
1200 N BRIDGE ST, CHILLICOTHE, OH 45601-1845
(740) 775-7226
(740) 773-7226
Mailing address
1200 N BRIDGE ST, CHILLICOTHE, OH 45601-1845
(740) 775-7226
(740) 773-7226
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
1118IC
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000342976
ANTHEM PIN
OH
05
—
2558870
—
OH
01
—
P00203268
RAILROAD MEDICARE
OH
Enumeration date
10/28/2005
Last updated
09/04/2007
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