Healthcare Provider Details

I. General information

NPI: 1346266798
Provider Name (Legal Business Name): PERRY COUNTY RADIOLOGICAL ASSOCIATES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL RD
TELL CITY IN
47586-2750
US

IV. Provider business mailing address

120 E ADAMS ST STE 4
LAGRANGE KY
40031-1278
US

V. Phone/Fax

Practice location:
  • Phone: 812-547-0190
  • Fax: 812-547-0188
Mailing address:
  • Phone: 502-222-3281
  • Fax: 502-225-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JANNICE O AARON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 502-222-3281