Provider Demographics
NPI:1518105196
Name:PRO IMAGING LEXINGTON
Entity Type:Organization
Organization Name:PRO IMAGING LEXINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:P
Authorized Official - Last Name:NETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-317-8285
Mailing Address - Street 1:523 WELLINGTON WAY STE 180
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1394
Mailing Address - Country:US
Mailing Address - Phone:859-317-8285
Mailing Address - Fax:
Practice Address - Street 1:523 WELLINGTON WAY STE 180
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1394
Practice Address - Country:US
Practice Address - Phone:859-317-8285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20235529261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center