1043314693 NPI number — X-RAY ASSOCIATES

Table of content: (NPI 1043314693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043314693 NPI number — X-RAY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
X-RAY ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043314693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 807
Provider Second Line Business Mailing Address:
X-RAY ASSOCIATES
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42302-0807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-685-5165
Provider Business Mailing Address Fax Number:
270-683-0256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 N MAIN ST
Provider Second Line Business Practice Location Address:
OHIO COUNTY HOSPITAL
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-685-5165
Provider Business Practice Location Address Fax Number:
270-683-0256
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARK
Authorized Official First Name:
FREDERIC
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT MEMBER
Authorized Official Telephone Number:
270-685-5165

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 65909160 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4355 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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