Healthcare Provider Details

I. General information

NPI: 1700831559
Provider Name (Legal Business Name): DIAGNOSTIC RADIOLOGY SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 RICHMOND RD SUITE 150
LEXINGTON KY
40509-2500
US

IV. Provider business mailing address

3475 RICHMOND RD SUITE 150
LEXINGTON KY
40509-2500
US

V. Phone/Fax

Practice location:
  • Phone: 859-275-2100
  • Fax: 859-223-3274
Mailing address:
  • Phone: 859-275-2100
  • Fax: 859-223-3274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number720250
License Number StateKY

VIII. Authorized Official

Name: MR. BRUCE MANOR
Title or Position: PRESIDENT
Credential:
Phone: 859-231-7644