Healthcare Provider Details

I. General information

NPI: 1114027133
Provider Name (Legal Business Name): PHYSICIANS BILLINGS DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 S 3RD ST
LOUISVILLE KY
40203-2902
US

IV. Provider business mailing address

1126 S 3RD ST
LOUISVILLE KY
40203-2902
US

V. Phone/Fax

Practice location:
  • Phone: 502-649-6414
  • Fax:
Mailing address:
  • Phone: 502-649-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: STEVE LOWERY
Title or Position: PRESIDENT
Credential:
Phone: 502-649-6414