1952395238 NPI number — PET CT MANAGEMENT LLC

Table of content: (NPI 1952395238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952395238 NPI number — PET CT MANAGEMENT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PET CT MANAGEMENT LLC
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:
6
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:
1952395238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7807 SHELBYVILLE RD
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40222-5439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-412-2725
Provider Business Mailing Address Fax Number:
502-412-2729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7807 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-5439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-412-2725
Provider Business Practice Location Address Fax Number:
502-412-2729
Provider Enumeration Date:
09/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
502-896-7672

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X , 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: 000000321134 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 86000429 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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