Provider Demographics
NPI:1902941735
Name:COSHOCTON RADIOLOGY, INC.
Entity Type:Organization
Organization Name:COSHOCTON RADIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:MAGNESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-622-7497
Mailing Address - Street 1:503 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2210
Mailing Address - Country:US
Mailing Address - Phone:740-622-8822
Mailing Address - Fax:740-622-4812
Practice Address - Street 1:503 S 16TH ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2210
Practice Address - Country:US
Practice Address - Phone:740-622-8822
Practice Address - Fax:740-622-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0311746Medicaid
OH0311746Medicaid