Healthcare Provider Details

I. General information

NPI: 1609102565
Provider Name (Legal Business Name): ASHLAND CARDIAC IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N EUGENE ST
GREENSBORO NC
27401-1622
US

IV. Provider business mailing address

1205 MONTGOMERY AVE
ASHLAND KY
41101-2669
US

V. Phone/Fax

Practice location:
  • Phone: 336-274-2844
  • Fax:
Mailing address:
  • Phone: 336-274-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: REGINALD RICHARD SIPE
Title or Position: MEMBER
Credential:
Phone: 336-274-2844