MEDICARE: KENTUCKY MEDICAL IMAGING ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073565248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENTUCKY MEDICAL IMAGING ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	1700 EASTPOINT PKWY
Second Line	:	SUITE 220
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4140
Country	:	US
Telephone Number	:	502-753-4949
Fax Number	:	502-753-4950

Provider Business Practice Location Address
First Line	:	1210 KY HIGHWAY 36 E
Second Line	:
City	:	CYNTHIANA
State	:	KY
Zip	:	41031-7498
Country	:	US
Telephone Number	:	859-234-2300
Fax Number	:	859-235-3699

Authorized Official
Title or Position	:	MEMBER
Name	:	DOUGLAS C CRUTCHER
Credential	:	MD
Telephone Number	:	859-229-0499

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	09/03/2015

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