MEDICARE: CHOICEONE DIAGNOSTICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1285317412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICEONE DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	2081 HARRODSBURG RD # 1046
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3503
Country	:	US
Telephone Number	:	859-379-4360
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 MOCKS CREEK DR
Second Line	:
City	:	DANVILLE
State	:	KY
Zip	:	40422-9255
Country	:	US
Telephone Number	:	859-583-3212
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	GEORGE RUGGLES
Credential	:
Telephone Number	:	859-379-4360

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	01/20/2025

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