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General NPI Number Information
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NPI Number | 1225187206
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Entity Type | Organization
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Legal Business Name | RUSSELL COUNTY RADIOLOGY, PSC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 153 DOWELL RD
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-4579
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Country | US
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Telephone | 270-866-4294
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Fax |
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Provider Business Mailing Address
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Address Line | 43 DOWELL RD
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-4236
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Country | US
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Telephone | 270-866-4294
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERRY DUKE WESTERFIELD
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Credential | M.D.
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Telephone | 270-866-4294
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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 | 14879
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License Number State | KY
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