Provider Demographics
NPI:1033235163
Name:IMAGING SERVICES
Entity Type:Organization
Organization Name:IMAGING SERVICES
Other - Org Name:CAPITAL MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUQUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-223-5811
Mailing Address - Street 1:PO BOX 4168
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40604-4168
Mailing Address - Country:US
Mailing Address - Phone:502-223-5811
Mailing Address - Fax:502-227-7379
Practice Address - Street 1:1001 LEAWOOD DR
Practice Address - Street 2:SUITE A
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-3375
Practice Address - Country:US
Practice Address - Phone:502-875-0872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL FAMILY PHYSICIANS, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-21
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY296592085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4919Medicare PIN