Basic Information
| Provider Information | |||||||||
| NPI: | 1184683112 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIRILLI | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1537 | ||||||||
| Address2: | |||||||||
| City: | GLASGOW | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421421537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706519129 | ||||||||
| FaxNumber: | 2706514916 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 N RACE ST | ||||||||
| Address2: | |||||||||
| City: | GLASGOW | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421413483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706514444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2006 | ||||||||
| LastUpdateDate: | 04/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 28412 | KY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000000057712 | 01 | KY | ANTHEM | OTHER | 64284128 | 05 | KY | MEDICAID |