=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730159435
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICIANS IMAGING PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2006
-----------------------------------------------------
Last Update Date | 04/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2483 HIGHWAY 644
-----------------------------------------------------
City | LOUISA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-638-9451
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1006
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41105-1006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-494-8267
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ROBERT B DAVIS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 606-368-9451
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------