MEDICARE: OSSP IMAGING OF LOUISVILLE

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	:	1932786449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSSP IMAGING OF LOUISVILLE

Provider Business Mailing Address
First Line	:	5788 ROSWELL RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4904
Country	:	US
Telephone Number	:	305-290-2448
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 BARRET AVE STE 104
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1732
Country	:	US
Telephone Number	:	502-371-5474
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	RA'KESHIA BROGDON
Credential	:
Telephone Number	:	404-941-1233

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	03/29/2021

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Directions to “OSSP IMAGING OF LOUISVILLE ” Practice Location

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