MEDICARE: DIAGNOSTIC MEDICAL IMAGING 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
1	261QR0200X	Radiology Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CC2698	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	:	1679535702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC MEDICAL IMAGING ASSOCIATES, PSC.

Provider Business Mailing Address
First Line	:	1108 DUPONT CIR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4804
Country	:	US
Telephone Number	:	502-897-0139
Fax Number	:	502-897-5337

Provider Business Practice Location Address
First Line	:	3900 DUPONT SQ S
Second Line	:	SUITE B
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4615
Country	:	US
Telephone Number	:	502-584-0128
Fax Number	:	502-584-0149

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JERI P. IRWIN
Credential	:	MD
Telephone Number	:	502-584-0128

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	10/19/2007

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Directions to “DIAGNOSTIC MEDICAL IMAGING ASSOCIATES, PSC. ” Practice Location

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