Provider Demographics
NPI:1538280078
Name:FLEMING REGIONAL MEDICAL IMAGING, PLLC
Entity Type:Organization
Organization Name:FLEMING REGIONAL MEDICAL IMAGING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-849-2323
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041
Mailing Address - Country:US
Mailing Address - Phone:606-845-0145
Mailing Address - Fax:
Practice Address - Street 1:730 ELIZAVILLE RD
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041
Practice Address - Country:US
Practice Address - Phone:606-845-0145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100010340Medicaid