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General NPI Number Information
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NPI Number | 1457480832
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Entity Type | Organization
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Legal Business Name | MAGGIES ENTERPRISES LLC
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Dates
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Enumeration Date | 03/03/2007
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 102 MOUNTAIN VIEW CMNS
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City | PINEVILLE
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State | KY
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Zip | 40977-8708
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Country | US
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Telephone | 606-269-7146
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Fax | 606-337-8839
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Provider Business Mailing Address
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Address Line | PO BOX 475
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City | PINEVILLE
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State | KY
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Zip | 40977-0475
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Country | US
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Telephone | 606-269-7146
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Fax | 606-337-8839
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CHANDA B SAMS
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Credential |
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Telephone | 606-269-7146
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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 | 142920
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License Number State | KY
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