1003837378 NPI number — DIAGNOSTIC IMAGING SHELBYVILLE, 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 1003837378 NPI number — DIAGNOSTIC IMAGING SHELBYVILLE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTIC IMAGING SHELBYVILLE, 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:
MEDICAL IMAGING SHELBYVILLE
Provider Other Organization Name Type Code:
5
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:
1003837378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 E ADAMS ST
Provider Second Line Business Mailing Address:
STE 4
Provider Business Mailing Address City Name:
LAGRANGE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40031-1278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-222-3281
Provider Business Mailing Address Fax Number:
502-225-5796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 STONECREST RD
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-647-0311
Provider Business Practice Location Address Fax Number:
502-647-6011
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AARON
Authorized Official First Name:
JANNICE
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
502-222-3281

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085N0904X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 50013806 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50013027 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50013647 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50013025 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50013029 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100001970 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50013026 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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