Healthcare Provider Details

I. General information

NPI: 1609061639
Provider Name (Legal Business Name): 1003 INVESTMENTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 BOWLING BLVD SUITE 100
LOUISVILLE KY
40207-5147
US

IV. Provider business mailing address

9120 S COUNTY ROAD 800 W
DALEVILLE IN
47334-9421
US

V. Phone/Fax

Practice location:
  • Phone: 502-500-6648
  • Fax: 502-297-8103
Mailing address:
  • Phone: 502-500-6648
  • Fax: 502-297-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number720296
License Number StateKY

VIII. Authorized Official

Name: MR. JASON ALLEN TAYLOR
Title or Position: REGIONAL MANAGER
Credential: R.T. (R)
Phone: 502-500-6648