Provider Demographics
NPI:1124073960
Name:DIAGNOSTIC RADIOLOGY SYSTEMS
Entity type:Organization
Organization Name:DIAGNOSTIC RADIOLOGY SYSTEMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-231-7644
Mailing Address - Street 1:601 W SHORT ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1246
Mailing Address - Country:US
Mailing Address - Phone:859-231-7644
Mailing Address - Fax:859-233-7644
Practice Address - Street 1:2425 REGENCY RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2948
Practice Address - Country:US
Practice Address - Phone:859-275-2100
Practice Address - Fax:859-275-1159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY730053261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY86030343Medicaid
KY1167041OtherCHA PIN
KY1600375OtherUHC PIN
KY5864584OtherAETNA PIN
KY000000073108OtherANTHEM PIN
KY6755OtherBGFH
KY86030343Medicaid
KY6755OtherBGFH