1922035443 NPI number — DOWNTOWN RADIOLOGY INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922035443 NPI number — DOWNTOWN RADIOLOGY INC

Employer Identification Number (EIN):

Provider Organization Name:

DOWNTOWN 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 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:

1922035443

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

08/22/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

123 N 19TH ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MIDDLESBORO

Provider Business Mailing Address State Name:

KY

Provider Business Mailing Address Postal Code:

40965-2865

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

606-248-3171

Provider Business Mailing Address Fax Number:

606-248-3206

Provider First Line Business Practice Location Address:

123 N. 19TH ST.

Provider Second Line Business Practice Location Address:

123 N. 19TH ST.

Provider Business Practice Location Address City Name:

MIDDLESBORO

Provider Business Practice Location Address State Name:

KY

Provider Business Practice Location Address Postal Code:

40965-4623

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

606-248-3171

Provider Business Practice Location Address Fax Number:

606-248-3206

Provider Enumeration Date:

06/28/2006

Authorized Official Last Name:

BAKER

Authorized Official First Name:

LULA

Authorized Official Middle Name:

M.

Authorized Official Title or Position:

OFFICE MANAGER

Authorized Official Telephone Number:

606-248-3171

• Taxonomy code: 2471C3402X , with the licence number:  730019 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
• Taxonomy code: 2471M2300X , with the licence number: 269570 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

• Identifier: 292804 . This is a "BLACK LUNG PROGRAM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 885 . This is a "CHA INSURANCE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 86010071 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 885 . This is a "BLUEGRASS FAMILY HLTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 885 . This is a "ACORDIA INS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 000000073139 . This is a "B/C B/SHIELD OF KY #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 000816234002 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 1403954 . This is a "UMWA INS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 7144 . This is a "CHA INSURANCE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".