Healthcare Provider Details

I. General information

NPI: 1922035443
Provider Name (Legal Business Name): DOWNTOWN RADIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N. 19TH ST. 123 N. 19TH ST.
MIDDLESBORO KY
40965-4623
US

IV. Provider business mailing address

123 N 19TH ST
MIDDLESBORO KY
40965-2865
US

V. Phone/Fax

Practice location:
  • Phone: 606-248-3171
  • Fax: 606-248-3206
Mailing address:
  • Phone: 606-248-3171
  • Fax: 606-248-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number730019
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License Number269570
License Number StateKY

VIII. Authorized Official

Name: MRS. LULA M. BAKER
Title or Position: OFFICE MANAGER
Credential: MANAGER
Phone: 606-248-3171