Provider Demographics
NPI:1477724482
Name:DAVID A. ESCALANTE, MD
Entity Type:Organization
Organization Name:DAVID A. ESCALANTE, MD
Other - Org Name:BONE DENSITOMETRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESCALANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-242-2196
Mailing Address - Street 1:PO BOX 1795
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-3795
Mailing Address - Country:US
Mailing Address - Phone:606-242-2196
Mailing Address - Fax:606-242-2586
Practice Address - Street 1:1632 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1378
Practice Address - Country:US
Practice Address - Phone:606-242-2196
Practice Address - Fax:606-242-2586
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID A. ESCALANTE, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-18
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000053979OtherANTHEM
KY1529202OtherUMWA
KY110182661OtherRRMEDICARE
KY65933350Medicaid
KY110182661OtherRRMEDICARE