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General NPI Number Information
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NPI Number | 1093122046
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Entity Type | Organization
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Legal Business Name | KBC SOMERSET IMAGING PLLC
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 40 TURPEN CT
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City | SOMERSET
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State | KY
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Zip | 42503-3464
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Country | US
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Telephone | 606-658-9535
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Fax | 606-658-9537
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Provider Business Mailing Address
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Address Line | PO BOX 278
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-0278
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Country | US
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Telephone | 606-219-4184
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Fax | 606-678-8368
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAWN ANDREA WOODROOF
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Credential |
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Telephone | 606-658-9535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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