Provider Demographics
NPI:1518991645
Name:PURCHASE RADIOLOGY GROUP
Entity Type:Organization
Organization Name:PURCHASE RADIOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-223-2250
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:PURCHASE RADIOLOGY GROUP
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025
Mailing Address - Country:US
Mailing Address - Phone:877-459-2290
Mailing Address - Fax:859-223-2732
Practice Address - Street 1:2000 HOLIDAY LANE
Practice Address - Street 2:PARKWAY REGIONAL HOSPITAL
Practice Address - City:FULTON
Practice Address - State:KY
Practice Address - Zip Code:42041
Practice Address - Country:US
Practice Address - Phone:877-459-2290
Practice Address - Fax:859-223-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
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
KY65904930Medicaid
KY5864OtherBCBS
KY5864OtherBCBS