Provider Demographics
NPI:1962624064
Name:CUMBERLAND RADIOLOGY PSC
Entity type:Organization
Organization Name:CUMBERLAND RADIOLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:606-256-4208
Mailing Address - Street 1:PO BOX 1270
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-1270
Mailing Address - Country:US
Mailing Address - Phone:706-226-6806
Mailing Address - Fax:706-226-6806
Practice Address - Street 1:145 PERCIFUL ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2740
Practice Address - Country:US
Practice Address - Phone:706-226-6806
Practice Address - Fax:706-226-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY257692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64257637Medicaid
KY000000349604OtherBCBS
KYC69380Medicare UPIN
KY64257637Medicaid