Provider Demographics
NPI:1639410418
Name:COMPREHENSIVE MRI CENTER LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE MRI CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-271-0055
Mailing Address - Street 1:215 TREUHAFT BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7361
Mailing Address - Country:US
Mailing Address - Phone:706-271-0055
Mailing Address - Fax:706-270-0487
Practice Address - Street 1:215 TREUHAFT BLVD
Practice Address - Street 2:STE 3
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7361
Practice Address - Country:US
Practice Address - Phone:706-271-0055
Practice Address - Fax:706-270-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY397062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty