Healthcare Provider Details

I. General information

NPI: 1518358191
Provider Name (Legal Business Name): SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 BARDSTOWN RD STE 103
LOUISVILLE KY
40218-3293
US

IV. Provider business mailing address

930 RIDGEBROOK RD 3RD FLOOR
SPARKS MD
21152-9390
US

V. Phone/Fax

Practice location:
  • Phone: 502-495-1848
  • Fax:
Mailing address:
  • Phone: 800-786-8015
  • Fax: 443-662-4230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: ANGELA M AMEY
Title or Position: VP REIMBURSEMENT
Credential:
Phone: 800-786-8015