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General NPI Number Information
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NPI Number | 1285884783
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Entity Type | Organization
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Legal Business Name | KENTUCKY MOUNTAIN IMAGING LLC
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 145 CITIZENS LN STE B
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City | HAZARD
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State | KY
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Zip | 41701-1320
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Country | US
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Telephone | 866-457-9896
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6070
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City | DALTON
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State | GA
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Zip | 30722-6070
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Country | US
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Telephone | 866-457-9896
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL D ELLIS
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Credential | MD
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Telephone | 866-457-9896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 39706
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License Number State | KY
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