Provider Demographics
NPI:1083676902
Name:DANVILLE RADIOLOGY ASSOCIATES PSC
Entity Type:Organization
Organization Name:DANVILLE RADIOLOGY ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-239-1220
Mailing Address - Street 1:PO BOX 2508
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2508
Mailing Address - Country:US
Mailing Address - Phone:866-388-4131
Mailing Address - Fax:866-505-6933
Practice Address - Street 1:217 S 3RD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1823
Practice Address - Country:US
Practice Address - Phone:859-239-1220
Practice Address - Fax:859-239-6719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000063422OtherBCBS
KY65904997Medicaid
KY0370Medicare PIN
KY65904997Medicaid