Basic Information
| Provider Information | |||||||||
| NPI: | 1609845064 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST OHIO X-RAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5156 | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458025156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192245707 | ||||||||
| FaxNumber: | 4192290040 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 SAINT CLAIR AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT MARYS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458852400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193943335 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | RAVIPATI | ||||||||
| AuthorizedOfficialFirstName: | SEETARAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4192382390 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 027970300 | 01 | FEDERAL BLACK LUNG PROG | OTHER | CA0584 | 01 | OH | RAILROAD MEDICARE | OTHER | 0610217 | 05 | OH | MEDICAID | 127859300 | 01 | DEPT OF LABOR - (FECA) | OTHER | 000000026829 | 01 | OH | ANTHEM BCBS | OTHER |