Provider Demographics
NPI:1437348737
Name:CENTRAL KENTUCKY IMAGING
Entity Type:Organization
Organization Name:CENTRAL KENTUCKY IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:DENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-259-5224
Mailing Address - Street 1:908 WALLACE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1479
Mailing Address - Country:US
Mailing Address - Phone:270-259-5224
Mailing Address - Fax:270-287-0173
Practice Address - Street 1:908 WALLACE AVE STE 102
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1479
Practice Address - Country:US
Practice Address - Phone:270-259-5224
Practice Address - Fax:270-287-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY250852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64250855Medicaid
KY9142Medicare PIN
KY64250855Medicaid