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General NPI Number Information
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NPI Number | 1902049513
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Entity Type | Organization
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Legal Business Name | CENTRAL KENTUCKY RADIOLOGY
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 04/13/2009
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Provider Practice Location Address
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Address Line | 124 DANIEL DR
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City | DANVILLE
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State | KY
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Zip | 40422-2527
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Country | US
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Telephone | 859-936-9974
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Fax | 859-936-0973
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Provider Business Mailing Address
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Address Line | 1218 S BROADWAY STE 310
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City | LEXINGTON
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State | KY
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Zip | 40504-2759
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Country | US
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Telephone | 859-219-0542
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Fax | 859-219-9433
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JON K KOSTELIC
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Credential | MD
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Telephone | 859-219-0542
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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 |
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