Provider Demographics
NPI:1124092721
Name:CENTRAL KENTUCKY COMPREHENSIVE IMAGING AND DIAGNOSTIC SERVICES LLC
Entity type:Organization
Organization Name:CENTRAL KENTUCKY COMPREHENSIVE IMAGING AND DIAGNOSTIC SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-437-2200
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0697
Mailing Address - Country:US
Mailing Address - Phone:606-439-2662
Mailing Address - Fax:606-439-0612
Practice Address - Street 1:225 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3217
Practice Address - Country:US
Practice Address - Phone:606-437-2200
Practice Address - Fax:606-437-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65941221Medicaid
KY9371701Medicare PIN
KYP00268888Medicare PIN