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NPI Code Detail

MEDICARE: MAYSVILLE RADIOLOGY ASSOCIATES, PSC

MEDICARE: MAYSVILLE RADIOLOGY ASSOCIATES, PSC
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
12085R0202XDiagnostic Radiology Physician19217KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000058821OTHERKYANTHEM BC/BS PIN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3C74139OTHERKYBLUEGRASS FAMILY HEALTH
48759011OTHERKYUNITED HEALTHCARE PIN
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447259197
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAYSVILLE RADIOLOGY ASSOCIATES, PSC
Provider Business Mailing Address
First Line : PO BOX 813
Second Line :
City : MAYSVILLE
State : KY
Zip : 41056-0813
Country : US
Telephone Number : 606-759-3130
Fax Number : 502-223-9829
Provider Business Practice Location Address
First Line : 989 MEDICAL PARK DR
Second Line :
City : MAYSVILLE
State : KY
Zip : 41056-8750
Country : US
Telephone Number : 606-759-3130
Fax Number : 502-223-9829
Authorized Official
Title or Position : PRESIDENT
Name : RICHARD S HARTMAN
Credential : MD
Telephone Number : 606-759-3130
Provider Enumeration Date : 07/15/2005
Last Update Date : 07/01/2014

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