Provider Demographics
NPI:1194774760
Name:TYSON, SCHWAB, SHORT & WEISS PSC
Entity type:Organization
Organization Name:TYSON, SCHWAB, SHORT & WEISS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-583-2731
Mailing Address - Street 1:222 S 1ST ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5404
Mailing Address - Country:US
Mailing Address - Phone:502-583-2731
Mailing Address - Fax:502-583-2733
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1818
Practice Address - Country:US
Practice Address - Phone:502-587-4231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529925200Medicaid
KY65901985Medicaid
IN100001620AMedicaid
KY000000063366OtherANTHEM BLUE FACET
IN100001620CMedicaid
KY1058376Medicaid
IN100001620EMedicaid
WV3810004746Medicaid
KYCD0227OtherRAILROAD MEDICARE
TX078680801Medicaid
IN100001620BMedicaid
OH2145128Medicaid
KY65901985Medicaid
AL529925200Medicaid
IN100001620EMedicaid
WV3810004746Medicaid