MEDICARE: 1003 INVESTMENTS, 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	720296	KY

General Provider Information

NPI Number	:	1609061639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1003 INVESTMENTS, LLC

Provider Business Mailing Address
First Line	:	9120 S COUNTY ROAD 800 W
Second Line	:
City	:	DALEVILLE
State	:	IN
Zip	:	47334-9421
Country	:	US
Telephone Number	:	502-500-6648
Fax Number	:	502-297-8103

Provider Business Practice Location Address
First Line	:	4500 BOWLING BLVD
Second Line	:	SUITE 100
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-5147
Country	:	US
Telephone Number	:	502-500-6648
Fax Number	:	502-297-8103

Authorized Official
Title or Position	:	REGIONAL MANAGER
Name	:	MR. JASON ALLEN TAYLOR
Credential	:	R.T. (R)
Telephone Number	:	502-500-6648

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	12/29/2011

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