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General NPI Number Information
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NPI Number | 1255430054
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC RADIOLOGY OF LONDON PSC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/02/2013
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Provider Practice Location Address
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Address Line | 75 WALMART PLAZA DR UNIT 4
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City | MONTICELLO
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State | KY
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Zip | 42633-7907
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Country | US
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Telephone | 606-340-0009
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Fax | 606-340-0113
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Provider Business Mailing Address
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Address Line | 75 WALMART PLAZA DR UNIT 4
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City | MONTICELLO
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State | KY
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Zip | 42633-7907
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Country | US
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Telephone | 606-340-0009
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Fax | 606-340-0113
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Authorized Official
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Title or Position | FACILITY DIRECTOR
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Name | MS. MARY JO SHRUM
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Credential |
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Telephone | 606-340-0009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 33556
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License Number State | KY
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