Provider Demographics
NPI:1700831559
Name:DIAGNOSTIC RADIOLOGY SYSTEMS INC
Entity Type:Organization
Organization Name:DIAGNOSTIC RADIOLOGY SYSTEMS INC
Other - Org Name:KENTUCKY METABOLIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-231-7644
Mailing Address - Street 1:3475 RICHMOND RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2500
Mailing Address - Country:US
Mailing Address - Phone:859-275-2100
Mailing Address - Fax:859-223-3274
Practice Address - Street 1:3475 RICHMOND RD
Practice Address - Street 2:SUITE 150
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2500
Practice Address - Country:US
Practice Address - Phone:859-275-2100
Practice Address - Fax:859-223-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY720250261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1700831559Medicaid
KY630001664OtherRAILROAD MEDICARE PIN
KY1600375OtherUHC PIN
KY5864584OtherAETNA PIN
KY1167041OtherCHA PIN
KY1167041OtherCHA PIN
KY9366001Medicare PIN
KY630001664OtherRAILROAD MEDICARE PIN