MEDICARE: SAFEGUARD RADIOLOGY INTERPRETATION SERVICES 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	111NR0200X	Radiology Chiropractor	4777	KY

General Provider Information

NPI Number	:	1871706531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFEGUARD RADIOLOGY INTERPRETATION SERVICES LLC

Provider Business Mailing Address
First Line	:	9462 BROWNSBORO RD # 268
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-1118
Country	:	US
Telephone Number	:	502-961-0111
Fax Number	:	502-427-7797

Provider Business Practice Location Address
First Line	:	6304 THOMAS CT
Second Line	:
City	:	PROSPECT
State	:	KY
Zip	:	40059-7515
Country	:	US
Telephone Number	:	502-961-0011
Fax Number	:	502-213-0820

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BROOKE L GAJESKI
Credential	:	D.C.
Telephone Number	:	502-387-5133

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	02/15/2024

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