Healthcare Provider Details

I. General information

NPI: 1083650568
Provider Name (Legal Business Name): RENAISSANCE NUCLEAR IMAGING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 WINCHESTER AVE
ASHLAND KY
41101-1962
US

IV. Provider business mailing address

2900 WINCHESTER AVE
ASHLAND KY
41101-1962
US

V. Phone/Fax

Practice location:
  • Phone: 606-920-9966
  • Fax: 606-920-9965
Mailing address:
  • Phone: 606-920-9966
  • Fax: 606-920-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number6206
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. CURTIS RAY NICHOLS II
Title or Position: OWNER
Credential: CNMT
Phone: 606-920-9966