Provider Demographics
NPI:1962438549
Name:IMAGE INTERPRETATION SERVICES LTD
Entity type:Organization
Organization Name:IMAGE INTERPRETATION SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:BALZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-266-4908
Mailing Address - Street 1:PO BOX 76648
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-6500
Mailing Address - Country:US
Mailing Address - Phone:740-266-4908
Mailing Address - Fax:740-264-4376
Practice Address - Street 1:112 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MINGO JCT
Practice Address - State:OH
Practice Address - Zip Code:43938-1463
Practice Address - Country:US
Practice Address - Phone:740-266-4908
Practice Address - Fax:740-264-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH350780001B2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2268460Medicaid
OH=========OtherFEDERAL TAX IDENTIFICATIO
OH2268460Medicaid