Healthcare Provider Details

I. General information

NPI: 1619954138
Provider Name (Legal Business Name): DIAGNOSTIC X-RAY PHYSICIANS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AUDUBON PLAZA DR
LOUISVILLE KY
40217-1318
US

IV. Provider business mailing address

9152 TAYLORSVILLE RD # 276
LOUISVILLE KY
40299-1752
US

V. Phone/Fax

Practice location:
  • Phone: 502-447-8786
  • Fax: 502-447-8623
Mailing address:
  • Phone: 502-447-8786
  • Fax: 502-447-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAREN D. REPISHTI
Title or Position: PRESIDENT
Credential: MD
Phone: 502-447-8786