Provider Demographics
NPI:1083650568
Name:RENAISSANCE NUCLEAR IMAGING SERVICES
Entity Type:Organization
Organization Name:RENAISSANCE NUCLEAR IMAGING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:II
Authorized Official - Credentials:CNMT
Authorized Official - Phone:606-920-9966
Mailing Address - Street 1:2900 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-1962
Mailing Address - Country:US
Mailing Address - Phone:606-920-9966
Mailing Address - Fax:606-920-9965
Practice Address - Street 1:2900 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1962
Practice Address - Country:US
Practice Address - Phone:606-920-9966
Practice Address - Fax:606-920-9965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2471B0102X, 2471N0900X, 2471V0105X
KY62062471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Multi-Specialty
No2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Multi-Specialty
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY86000619Medicaid
KY9377101Medicare ID - Type UnspecifiedADMINISTAR FEDERAL