1962492066 NPI number — NORTHEAST KENTUCKY IMAGING INC

Table of content: (NPI 1962492066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962492066 NPI number — NORTHEAST KENTUCKY IMAGING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST KENTUCKY IMAGING 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:
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:
1962492066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX M
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELL
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41169-0510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-286-5888
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 SAINT CHRISTOPHER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-7034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-833-2273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DEGIORGIO
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
866-286-5888

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: 65908204 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0202995000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2610786 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810004299 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810004361 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2610777 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810004300 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810004320 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810004338 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2610811 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2610857 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810004362 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0524696 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2610802 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2610839 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000063419 . This is a "BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2610820 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810004321 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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