Healthcare Provider Details

I. General information

NPI: 1780708545
Provider Name (Legal Business Name): DIGITAL SPINE DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 BISHOP LN SUITE 710
LOUISVILLE KY
40218-1922
US

IV. Provider business mailing address

1941 BISHOP LN SUITE 710
LOUISVILLE KY
40218-1922
US

V. Phone/Fax

Practice location:
  • Phone: 502-454-0047
  • Fax:
Mailing address:
  • Phone: 502-454-0047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number220707
License Number StateKY

VIII. Authorized Official

Name: MR. RONALD L HORN
Title or Position: PRESIDENT
Credential:
Phone: 502-454-0047