Provider Demographics
NPI:1194310144
Name:BANFIELD DIAGNOSTIC IMAGING, LLC
Entity type:Organization
Organization Name:BANFIELD DIAGNOSTIC IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)
Authorized Official - Phone:606-545-8154
Mailing Address - Street 1:17 AMBER DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-9406
Mailing Address - Country:US
Mailing Address - Phone:606-545-8154
Mailing Address - Fax:
Practice Address - Street 1:17 AMBER DR
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-9406
Practice Address - Country:US
Practice Address - Phone:606-545-8154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier