Healthcare Provider Details

I. General information

NPI: 1407010051
Provider Name (Legal Business Name): FRG KENTUCKY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 RIVERVIEW RD
PINEVILLE KY
40977-1430
US

IV. Provider business mailing address

PO BOX 60
PITTSBURGH PA
15230-0060
US

V. Phone/Fax

Practice location:
  • Phone: 606-337-3051
  • Fax:
Mailing address:
  • Phone: 412-937-5726
  • Fax: 412-937-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDON CHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 412-223-2272