1083676902 NPI number — DANVILLE RADIOLOGY ASSOCIATES PSC

Table of content: (NPI 1083676902)

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".




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