Basic Information
| Provider Information | |||||||||
| NPI: | 1730125535 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL RADIOLOGY ASSOCIATES, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1429 | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 406021429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022263858 | ||||||||
| FaxNumber: | 5022239829 | ||||||||
| Practice Location | |||||||||
| Address1: | 781 EASTERN BYP | ||||||||
| Address2: | PATTIE A. CLAY HOSPITAL | ||||||||
| City: | RICHMOND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404752408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596238827 | ||||||||
| FaxNumber: | 8596238810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCQUAIDE | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | HOMER | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8596238827 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 65936825 | 05 | KY | MEDICAID |