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General NPI Number Information
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NPI Number | 1558314534
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Entity Type | Organization
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Legal Business Name | BLUEGRASS RADIOLOGY ASSOCIATES INC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 305 LANGDON ST
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City | SOMERSET
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State | KY
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Zip | 42503-2750
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Country | US
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Telephone | 606-679-7441
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Fax | 606-678-9919
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Provider Business Mailing Address
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Address Line | PO BOX 2425
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-2425
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Country | US
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Telephone | 866-388-4129
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Fax | 866-505-6937
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM M BAKER
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Credential | MD
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Telephone | 606-679-7441
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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 |
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License Number State | KY
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