Healthcare Provider Details

I. General information

NPI: 1184223190
Provider Name (Legal Business Name): APTIVA HEALTH IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 NEWBURG RD STE 106
LOUISVILLE KY
40218-3368
US

IV. Provider business mailing address

3615 NEWBURG RD STE 106
LOUISVILLE KY
40218-3368
US

V. Phone/Fax

Practice location:
  • Phone: 502-909-0772
  • Fax: 855-859-0123
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC LOWE
Title or Position: CEO
Credential:
Phone: 502-909-0772