1083676902 NPI number — DANVILLE RADIOLOGY ASSOCIATES PSC

Table of content: DR. BRANDON MICHAEL JOHNSON D.M.D., M.S.D. (NPI 1972804573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083676902 NPI number — DANVILLE RADIOLOGY ASSOCIATES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANVILLE RADIOLOGY ASSOCIATES PSC
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:
1083676902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2508
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46206-2508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-388-4131
Provider Business Mailing Address Fax Number:
866-505-6933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 S 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40422-1823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-239-1220
Provider Business Practice Location Address Fax Number:
859-239-6719
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOPPER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-239-1220

Provider Taxonomy Codes

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

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

  • Identifier: 000000063422 . This is a "BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65904997 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com