Provider Demographics
NPI:1225030901
Name:KENTUCKIANA DIAGNOSTICS
Entity Type:Organization
Organization Name:KENTUCKIANA DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-288-9838
Mailing Address - Street 1:301 SOUTHERN INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3204
Mailing Address - Country:US
Mailing Address - Phone:812-288-9838
Mailing Address - Fax:812-288-6975
Practice Address - Street 1:301 SOUTHERN INDIANA AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3204
Practice Address - Country:US
Practice Address - Phone:812-288-9838
Practice Address - Fax:812-288-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN165800Medicare ID - Type Unspecified