Provider Demographics
NPI:1386695559
Name:ZANESVILLE IMAGING CENTER, LLC
Entity type:Organization
Organization Name:ZANESVILLE IMAGING CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF IMAGING
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MELICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-586-6500
Mailing Address - Street 1:2800 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1717
Mailing Address - Country:US
Mailing Address - Phone:740-454-4009
Mailing Address - Fax:740-586-6701
Practice Address - Street 1:2800 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1717
Practice Address - Country:US
Practice Address - Phone:740-454-4009
Practice Address - Fax:740-586-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Not Answered261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHZAID02771Medicare ID - Type Unspecified
Y51722Medicare UPIN