Provider Demographics
NPI:1225187206
Name:RUSSELL COUNTY RADIOLOGY, PSC
Entity Type:Organization
Organization Name:RUSSELL COUNTY RADIOLOGY, PSC
Other - Org Name:IMAGING ASSOCIATES OF RUSSELL COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:DUKE
Authorized Official - Last Name:WESTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-866-4294
Mailing Address - Street 1:43 DOWELL RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-4236
Mailing Address - Country:US
Mailing Address - Phone:270-866-4294
Mailing Address - Fax:
Practice Address - Street 1:153 DOWELL RD
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4579
Practice Address - Country:US
Practice Address - Phone:270-866-4294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY148792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65940991Medicaid
KY65940991Medicaid
9048Medicare PIN
KYDB3538Medicare PIN
D53809Medicare UPIN