1952395238 NPI number — PET CT MANAGEMENT LLC

Table of Contents

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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