Provider Demographics
NPI:1326260720
Name:EASTERN KENTUCKY IMAGING, PSC
Entity Type:Organization
Organization Name:EASTERN KENTUCKY IMAGING, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:N
Authorized Official - Last Name:ZAMBOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-836-4929
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0148
Mailing Address - Country:US
Mailing Address - Phone:606-836-4929
Mailing Address - Fax:606-836-3185
Practice Address - Street 1:5000 KY RT 321
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-836-4929
Practice Address - Fax:606-836-3185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY258542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65941494Medicaid
WV7200028000OtherWEST VIRGINIA MEDICAID
KY000000332784OtherANTHEM BLUE SHIELD
KY000000332784OtherANTHEM BLUE SHIELD
WV7200028000OtherWEST VIRGINIA MEDICAID