Provider Demographics
NPI:1619061116
Name:UNIVERSITY PHYSICIANS GROUP - RADIOLOGY
Entity Type:Organization
Organization Name:UNIVERSITY PHYSICIANS GROUP - RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-562-5765
Mailing Address - Street 1:922 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206
Mailing Address - Country:US
Mailing Address - Phone:502-581-1599
Mailing Address - Fax:502-581-1548
Practice Address - Street 1:530 SOUTH JACKSON STREET
Practice Address - Street 2:RADIOLOGY CLINIC
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-562-6069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65905887Medicaid
KY6361Medicare ID - Type Unspecified