Healthcare Provider Details

I. General information

NPI: 1730125535
Provider Name (Legal Business Name): PROFESSIONAL RADIOLOGY ASSOCIATES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 EASTERN BYP PATTIE A. CLAY HOSPITAL
RICHMOND KY
40475-2408
US

IV. Provider business mailing address

PO BOX 1429
FRANKFORT KY
40602-1429
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-8827
  • Fax: 859-623-8810
Mailing address:
  • Phone: 502-226-3858
  • Fax: 502-223-9829

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: BENJAMIN HOMER MCQUAIDE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 859-623-8827