1700831559 NPI number — DIAGNOSTIC RADIOLOGY SYSTEMS INC

Table of content: (NPI 1700831559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700831559 NPI number — DIAGNOSTIC RADIOLOGY SYSTEMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTIC RADIOLOGY SYSTEMS INC
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:
1700831559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3475 RICHMOND RD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40509-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-275-2100
Provider Business Mailing Address Fax Number:
859-223-3274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3475 RICHMOND RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-275-2100
Provider Business Practice Location Address Fax Number:
859-223-3274
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANOR
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-231-7644

Provider Taxonomy Codes

  • Taxonomy code: 261QR0208X , with the licence number:  720250 , 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: 1700831559 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 630001664 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1600375 . This is a "UHC PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5864584 . This is a "AETNA PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1167041 . This is a "CHA PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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