1447259197 NPI number — MAYSVILLE RADIOLOGY ASSOCIATES, PSC

Table of content: (NPI 1447259197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447259197 NPI number — MAYSVILLE RADIOLOGY ASSOCIATES, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYSVILLE 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:
1447259197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 813
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41056-0813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-759-3130
Provider Business Mailing Address Fax Number:
502-223-9829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
989 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41056-8750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-759-3130
Provider Business Practice Location Address Fax Number:
502-223-9829
Provider Enumeration Date:
07/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARTMAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
606-759-3130

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  19217 , 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: 000000058821 . This is a "ANTHEM BC/BS PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64192172 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: C74139 . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 8759011 . This is a "UNITED HEALTHCARE PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 018259000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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