MEDICARE: CENTRAL KENTUCKY RADIOLOGY PLLC

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	363A00000X	Physician Assistant
2	2085R0202X	Diagnostic Radiology Physician

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
2	000000061387	OTHER	KY	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952350761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL KENTUCKY RADIOLOGY PLLC

Provider Business Mailing Address
First Line	:	651 PERIMETER DR STE 390
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4134
Country	:	US
Telephone Number	:	859-219-0542
Fax Number	:	859-219-9433

Provider Business Practice Location Address
First Line	:	651 PERIMETER DR STE 690
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4356
Country	:	US
Telephone Number	:	859-219-0542
Fax Number	:	859-219-9433

Authorized Official
Title or Position	:	CEO
Name	:	MRS. JULIE COFFEY
Credential	:
Telephone Number	:	859-219-0542

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	03/27/2026

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