MEDICARE: MIDWEST RADIOLOGY KENTUCKY 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	261QR0208X	Mobile Radiology Clinic/Center	720176	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00089265	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336289107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST RADIOLOGY KENTUCKY LLC

Provider Business Mailing Address
First Line	:	PO BOX 56046
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-0046
Country	:	US
Telephone Number	:	317-595-6040
Fax Number	:	317-595-6050

Provider Business Practice Location Address
First Line	:	4500 BOWLING BLVD STE 100
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-5147
Country	:	US
Telephone Number	:	317-595-6040
Fax Number	:	317-595-6050

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	STEVEN GANOTE
Credential	:
Telephone Number	:	317-557-6165

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	02/19/2008

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