Provider Demographics
NPI:1457440893
Name:REGIONAL RADIOLOGY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:REGIONAL RADIOLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSMARY
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHIBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-441-4275
Mailing Address - Street 1:225 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7914
Mailing Address - Country:US
Mailing Address - Phone:270-441-4275
Mailing Address - Fax:270-441-4197
Practice Address - Street 1:225 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 203
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-441-4275
Practice Address - Fax:270-441-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65936387Medicaid
KY6623Medicare ID - Type Unspecified