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General NPI Number Information
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NPI Number | 1205858099
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Entity Type | Organization
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Legal Business Name | SOMERSET OUTPATIENT DIAGNOSTIC CENTER
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 600 BOGLE ST SUITE 3
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City | SOMERSET
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State | KY
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Zip | 42503-2885
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Country | US
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Telephone | 606-678-4114
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Fax | 606-679-5862
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Provider Business Mailing Address
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Address Line | 600 BOGLE ST SUITE 3
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City | SOMERSET
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State | KY
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Zip | 42503-2885
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Country | US
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Telephone | 606-678-4114
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Fax | 606-679-5862
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LISA ANN MITCHELL
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Credential |
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Telephone | 606-678-4114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471M2300X
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Taxonomy Name | Mammography Radiologic Technologist
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License Number | FDA #169292
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License Number State | KY
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