Basic Information
| Provider Information | |||||||||
| NPI: | 1639410418 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE MRI CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 TREUHAFT BLVD | ||||||||
| Address2: | STE 3 | ||||||||
| City: | BARBOURVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 409067361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062710055 | ||||||||
| FaxNumber: | 7062700487 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 TREUHAFT BLVD | ||||||||
| Address2: | STE 3 | ||||||||
| City: | BARBOURVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 409067361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062710055 | ||||||||
| FaxNumber: | 7062700487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2013 | ||||||||
| LastUpdateDate: | 10/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | ELLIS | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7062710055 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 39706 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.