Provider Demographics
NPI:1093122046
Name:KBC SOMERSET IMAGING PLLC
Entity Type:Organization
Organization Name:KBC SOMERSET IMAGING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:WOODROOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-658-9535
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-0278
Mailing Address - Country:US
Mailing Address - Phone:606-219-4184
Mailing Address - Fax:606-678-8368
Practice Address - Street 1:40 TURPEN CT
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3464
Practice Address - Country:US
Practice Address - Phone:606-658-9535
Practice Address - Fax:606-658-9537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty