1033146105 NPI number — KENTUCKY BREAST IMAGING PLLC

Table of content: (NPI 1033146105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033146105 NPI number — KENTUCKY BREAST IMAGING PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKY BREAST IMAGING PLLC
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:
TAMARA PATSEY PLLC
Provider Other Organization Name Type Code:
4
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:
1033146105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 950151
Provider Second Line Business Mailing Address:
DEPT 52904
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40295-0151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-459-2290
Provider Business Mailing Address Fax Number:
859-223-2732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1740 NICHOLASVILLE RD
Provider Second Line Business Practice Location Address:
CENTRAL BAPTIST HOSPITAL
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-459-2290
Provider Business Practice Location Address Fax Number:
859-223-2732
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATSEY
Authorized Official First Name:
TAMARA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-260-6956

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: 309892 . This is a "BS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64306947 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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