1518991645 NPI number — PURCHASE RADIOLOGY GROUP

Table of content: (NPI 1518991645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518991645 NPI number — PURCHASE RADIOLOGY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PURCHASE RADIOLOGY GROUP
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:
1518991645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 227
Provider Second Line Business Mailing Address:
PURCHASE RADIOLOGY GROUP
Provider Business Mailing Address City Name:
BENTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-459-2290
Provider Business Mailing Address Fax Number:
859-223-2732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 HOLIDAY LANE
Provider Second Line Business Practice Location Address:
PARKWAY REGIONAL HOSPITAL
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-459-2290
Provider Business Practice Location Address Fax Number:
859-223-2732
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHANDLER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-223-2250

Provider Taxonomy Codes

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

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

  • Identifier: 65904930 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5864 . This is a "BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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