MEDICARE: NORTHEAST KENTUCKY IMAGING INC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	000000063419	OTHER	KY	BCBS
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962492066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST KENTUCKY IMAGING INC

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

Provider Business Practice Location Address
First Line	:	1000 SAINT CHRISTOPHER DR
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41101-7034
Country	:	US
Telephone Number	:	606-833-2273
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EUGENE R DEGIORGIO
Credential	:	MD
Telephone Number	:	866-286-5888

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	07/24/2008

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MEDICARE: NORTHEAST KENTUCKY IMAGING INC

Scope of Practice

Other Identifiers

General Provider Information

Similar Medicare Providers

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