1891749289 NPI number — TAYLOR COUNTY RADIOLOGY, PSC

Table of content: (NPI 1891749289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891749289 NPI number — TAYLOR COUNTY RADIOLOGY, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAYLOR COUNTY RADIOLOGY, 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:
1891749289
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:
103 WIND HAVEN DR
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
NICHOLASVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40356-8025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-282-9221
Provider Business Mailing Address Fax Number:
859-223-2732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 OLD LEBANON RD
Provider Second Line Business Practice Location Address:
TAYLOR COUNTY HOSPITAL
Provider Business Practice Location Address City Name:
CAMPBELLSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42718-9662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-282-9221
Provider Business Practice Location Address Fax Number:
859-223-2273
Provider Enumeration Date:
05/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HART
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
800-646-4741

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  29433 , 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)