| NPI | 1780687798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE DOUGLAS Credentialing Manager 502-403-1401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0200X Clinic/Center, Radiology |
| Additional Taxonomies | 261QM1200X Clinic/Center, Magnetic Resonance Imaging (MRI) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2010-01-27 |