1245368125 NPI number — NARRA RADIOLOGY INC.

Table of content: (NPI 1245368125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245368125 NPI number — NARRA RADIOLOGY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NARRA RADIOLOGY INC.
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:
MINGO PIKE RADIOLOGY INC
Provider Other Organization Name Type Code:
3
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:
1245368125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 CENTRAL AVE
Provider Second Line Business Mailing Address:
#1
Provider Business Mailing Address City Name:
SOUTH WILLIAMSON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41503-4149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-237-6300
Provider Business Mailing Address Fax Number:
606-237-7444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 CENTRAL AVE
Provider Second Line Business Practice Location Address:
#1
Provider Business Practice Location Address City Name:
SOUTH WILLIAMSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41503-4149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-237-6300
Provider Business Practice Location Address Fax Number:
606-237-7444
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NARRA
Authorized Official First Name:
BAPUJI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
606-237-6300

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  21656 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 21656 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1025204 . This is a "WV COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1045897 . This is a "CAMBRIDGE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 65932956 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300097776 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65036 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65041 . This is a "BC/BS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 02772 . This is a "AETNA NETWORK ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64216567 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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