Provider Demographics
NPI:1649383985
Name:KNOX COUNTY RADIOLOGY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:KNOX COUNTY RADIOLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:BOLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-546-7200
Mailing Address - Street 1:215 TREUHAFT BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906
Mailing Address - Country:US
Mailing Address - Phone:606-546-7200
Mailing Address - Fax:606-546-7221
Practice Address - Street 1:215 TREUHAFT BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906
Practice Address - Country:US
Practice Address - Phone:606-546-7200
Practice Address - Fax:606-546-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000204791OtherANTHEM
KY65934499Medicaid
KY65934499Medicaid