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General NPI Number Information
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NPI Number | 1326260720
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Entity Type | Organization
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Legal Business Name | EASTERN KENTUCKY IMAGING, PSC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5000 KY RT 321 RADIOLOGY DEPARTMENT
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City | PRESTONSBURG
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State | KY
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Zip | 41653-9113
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Country | US
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Telephone | 606-836-4929
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Fax | 606-836-3185
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Provider Business Mailing Address
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Address Line | PO BOX 148
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City | ASHLAND
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State | KY
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Zip | 41105-0148
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Country | US
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Telephone | 606-836-4929
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Fax | 606-836-3185
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Authorized Official
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Title or Position | OWNER
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Name | MR. PHILIP N ZAMBOS
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Credential | MD
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Telephone | 606-836-4929
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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 | 25854
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License Number State | KY
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