Provider Demographics
NPI:1073565248
Name:KENTUCKY MEDICAL IMAGING ASSOCIATES LLC
Entity Type:Organization
Organization Name:KENTUCKY MEDICAL IMAGING ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:CRUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-229-0499
Mailing Address - Street 1:1700 EASTPOINT PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4140
Mailing Address - Country:US
Mailing Address - Phone:502-753-4949
Mailing Address - Fax:502-753-4950
Practice Address - Street 1:1210 KY HIGHWAY 36 E
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7498
Practice Address - Country:US
Practice Address - Phone:859-234-2300
Practice Address - Fax:859-235-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65904617Medicaid
KY65904617Medicaid
KY6426Medicare PIN