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General NPI Number Information
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NPI Number | 1952423691
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Entity Type | Organization
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Legal Business Name | MAYSVILLE DIAGNOSTIC CENTER LLC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 04/28/2009
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Provider Practice Location Address
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Address Line | 910 KENTON STATION DR SUITE E
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City | MAYSVILLE
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State | KY
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Zip | 41056-9658
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Country | US
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Telephone | 606-759-0073
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Fax | 606-759-0075
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Provider Business Mailing Address
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Address Line | 910 KENTON STATION DR SUITE E
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City | MAYSVILLE
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State | KY
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Zip | 41056-9658
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Country | US
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Telephone | 606-759-0073
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Fax | 606-759-0075
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MRS. DONNA ISHMAEL
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Credential |
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Telephone | 606-759-0073
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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 | 730123
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | 730122
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 730123
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License Number State | KY
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