NPIMap

Organization Active NPI

Fairfield Diagnostic Imaging, LLC

  • Diagnostic Radiology Physician
  • Lancaster, OH
National Provider Identifier
1063472884
Registry record updated Jul 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
FAIRFIELD DIAGNOSTIC IMAGING, LLC
Practice address
1241 River Valley Blvd
Lancaster, OH 43130-1653
Phone
(740) 654-6312
NPI assigned
Mar 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark Antal
Title
Practice / Business Manager
Phone
(740) 654-6312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

1241 River Valley Blvd
Lancaster, OH 43130-1653

Mailing address

PO Box 1523
Lima, OH 45802-1523
Phone (419) 224-5707

Other identifiers 4

IdentifierTypeStateIssuer
000000162681OtherOHANTHEM BCBS
124621800OtherDEPT OF LABOR--FECA
2064779MedicaidOH
CI3266OtherOHRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

1241 River Valley Blvd
Lancaster, OH 43130
Phone (740) 654-6312

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309996800000",
    "number": "1063472884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1523",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458021523",
            "telephone_number": "419-224-5707",
            "fax_number": "419-229-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 RIVER VALLEY BLVD",
            "city": "LANCASTER",
            "state": "OH",
            "postal_code": "431301653",
            "telephone_number": "740-654-6312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFIELD DIAGNOSTIC IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-24",
        "last_updated": "2011-07-07",
        "status": "A",
        "authorized_official_last_name": "ANTAL",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRACTICE / BUSINESS MANAGER",
        "authorized_official_telephone_number": "740-654-6312"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000162681",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR--FECA",
            "identifier": "124621800",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2064779",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CI3266",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.