MEDICARE: TELERAD OF KENTUCKY ACCOUNT MANAGEMENT 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1952722142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELERAD OF KENTUCKY ACCOUNT MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	13737 NOEL RD
Second Line	:	STE 1600
City	:	DALLAS
State	:	TX
Zip	:	75240-1331
Country	:	US
Telephone Number	:	973-251-1132
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 WEST LN
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-9614
Country	:	US
Telephone Number	:	973-251-1132
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KATHLEEN KONDAS
Credential	:
Telephone Number	:	973-251-1132

Provider Enumeration Date	:	12/15/2013
Last Update Date	:	12/06/2019

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