Healthcare Provider Details

I. General information

NPI: 1285025395
Provider Name (Legal Business Name): ASHLAND RADIOLOGY ASSOCIATES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 LEXINGTON AVE
ASHLAND KY
41101-2843
US

IV. Provider business mailing address

2754 SOLUTION CTR
CHICAGO IL
60677-2007
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-0727
  • Fax:
Mailing address:
  • Phone: 606-260-4144
  • Fax: 606-862-7605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PAUL WESLEY LEWIS
Title or Position: PRESIDENT
Credential:
Phone: 606-923-9280