Basic Information
| Provider Information | |||||||||
| NPI: | 1093122046 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KBC SOMERSET IMAGING PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 278 | ||||||||
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| City: | RUSSELL SPRINGS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 426420278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062194184 | ||||||||
| FaxNumber: | 6066788368 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 TURPEN CT | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425033464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066589535 | ||||||||
| FaxNumber: | 6066589537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2014 | ||||||||
| LastUpdateDate: | 05/02/2017 | ||||||||
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| AuthorizedOfficialLastName: | WOODROOF | ||||||||
| AuthorizedOfficialFirstName: | DAWN | ||||||||
| AuthorizedOfficialMiddleName: | ANDREA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6066589535 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.