Provider Demographics
NPI:1104006113
Name:PIKEVILLE RADIOLOGY
Entity type:Organization
Organization Name:PIKEVILLE RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:POULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-432-1357
Mailing Address - Street 1:PO BOX 2648
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2648
Mailing Address - Country:US
Mailing Address - Phone:606-432-1357
Mailing Address - Fax:606-432-2457
Practice Address - Street 1:387 TOWN MOUNTAIN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1640
Practice Address - Country:US
Practice Address - Phone:606-432-9094
Practice Address - Fax:606-432-1832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0958131OtherUMWA
KY65932626Medicaid
KYCB5786Medicare PIN
KY0558Medicare PIN