=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023191475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RADIOLOGY STAFFING SOLUTIONS, PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 ZORN AVE
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40206-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-897-1900
-----------------------------------------------------
Fax | 502-893-4241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 605 ZORN AVE
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40206-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-897-1900
-----------------------------------------------------
Fax | 502-893-4241
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LOUIS BERMAN KASTAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 502-897-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 16990
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------