=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184866030
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEVIN J. CROCE, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2009
-----------------------------------------------------
Last Update Date | 08/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 LORETTO RD
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40033-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-539-9190
-----------------------------------------------------
Fax | 866-213-9002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 LORETTO RD
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40033-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-539-9190
-----------------------------------------------------
Fax | 866-213-9002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | KEVIN J CROCE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 859-539-9190
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 42537
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------