Provider Demographics
NPI:1679535702
Name:DIAGNOSTIC MEDICAL IMAGING ASSOCIATES, PSC.
Entity Type:Organization
Organization Name:DIAGNOSTIC MEDICAL IMAGING ASSOCIATES, PSC.
Other - Org Name:DMIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERI
Authorized Official - Middle Name:P
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-584-0128
Mailing Address - Street 1:1108 DUPONT CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4804
Mailing Address - Country:US
Mailing Address - Phone:502-897-0139
Mailing Address - Fax:502-897-5337
Practice Address - Street 1:3900 DUPONT SQ S
Practice Address - Street 2:SUITE B
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4615
Practice Address - Country:US
Practice Address - Phone:502-584-0128
Practice Address - Fax:502-584-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65914947Medicaid
KYCC2698OtherRAILROAD MEDICARE
KY0657Medicare PIN