Provider Demographics
NPI:1477579084
Name:PROFESSIONAL MRI, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:HOMER
Authorized Official - Last Name:MCQUAIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-623-8823
Mailing Address - Street 1:PO BOX 1429
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40602-1429
Mailing Address - Country:US
Mailing Address - Phone:502-226-3858
Mailing Address - Fax:502-223-9829
Practice Address - Street 1:803 EASTERN BYP
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2751
Practice Address - Country:US
Practice Address - Phone:859-623-8823
Practice Address - Fax:859-623-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000310923OtherANTHEM GROUP PIN
KY65939126Medicaid
KY000000310923OtherANTHEM GROUP PIN