Provider Demographics
NPI:1497780753
Name:KD IMAGING LLC
Entity Type:Organization
Organization Name:KD IMAGING LLC
Other - Org Name:KENTUCKIANA DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-288-9837
Mailing Address - Street 1:301 SOUTHERN INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3204
Mailing Address - Country:US
Mailing Address - Phone:812-288-9838
Mailing Address - Fax:812-288-6975
Practice Address - Street 1:301 SOUTHERN INDIANA AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3204
Practice Address - Country:US
Practice Address - Phone:812-288-9838
Practice Address - Fax:812-288-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory