Provider Demographics
NPI:1164664330
Name:PRO IMAGING LEXINGTON
Entity Type:Organization
Organization Name:PRO IMAGING LEXINGTON
Other - Org Name:DIAGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:P
Authorized Official - Last Name:NETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-317-8285
Mailing Address - Street 1:523 WELLLINGTON WAY SUITE 180
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502
Mailing Address - Country:US
Mailing Address - Phone:859-317-8285
Mailing Address - Fax:859-317-8285
Practice Address - Street 1:523 WELLLINGTON WAY
Practice Address - Street 2:180
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502
Practice Address - Country:US
Practice Address - Phone:859-317-8285
Practice Address - Fax:859-317-8285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20235529261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology