MEDICARE: HORSLEY, PSC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician
2	261QR0200X	Radiology Clinic/Center

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300102264	OTHER	KY	MEDICARE RR

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

NPI Number	:	1174526982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORSLEY, PSC

Provider Business Mailing Address
First Line	:	611 HAMMOND PLZ
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-4971
Country	:	US
Telephone Number	:	270-885-1950
Fax Number	:	270-885-4431

Provider Business Practice Location Address
First Line	:	611 HAMMOND PLZ
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-4971
Country	:	US
Telephone Number	:	270-885-1950
Fax Number	:	270-885-4431

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	MRS. MICHELLE DOUGLAS
Credential	:
Telephone Number	:	502-403-1401

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	02/17/2014

611 HAMMOND PLZ
HOPKINSVILLE, KY
42240-4971

Practice Phone: 270-885-1950
Practice Fax:

607 HAMMOND PLZ
HOPKINSVILLE, KY
42240-4971