Provider Demographics
NPI:1417975459
Name:JANE TODD HOSPITAL RADIOLOGICAL ASSOCIATES,LLC
Entity Type:Organization
Organization Name:JANE TODD HOSPITAL RADIOLOGICAL ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANNICE
Authorized Official - Middle Name:O
Authorized Official - Last Name:AARON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-222-3281
Mailing Address - Street 1:120 E ADAMS ST
Mailing Address - Street 2:STE 4
Mailing Address - City:LAGRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-1278
Mailing Address - Country:US
Mailing Address - Phone:502-222-3281
Mailing Address - Fax:502-225-5796
Practice Address - Street 1:202-206 MILBY STREET
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743
Practice Address - Country:US
Practice Address - Phone:270-932-4211
Practice Address - Fax:270-932-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65934010Medicaid
KYCB2755OtherRAILROAD MEDICARE GROUP
KY6655Medicare ID - Type Unspecified