Basic Information
| Provider Information | |||||||||
| NPI: | 1639115447 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISVILLE RADIOLOGY IMAGING CONSULTANTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 208787 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753208787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884135458 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 PLEASANT VALLEY RD | ||||||||
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| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423039811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089155671 | ||||||||
| FaxNumber: | 7089154022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | CASSIN | ||||||||
| AuthorizedOfficialFirstName: | NAOMI | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSOCIATE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3127248477 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.