Provider Demographics
NPI:1710981311
Name:MEDICAL IMAGING CONSULTANTS, PSC
Entity Type:Organization
Organization Name:MEDICAL IMAGING CONSULTANTS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:COOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-897-3214
Mailing Address - Street 1:PO BOX 950153
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0153
Mailing Address - Country:US
Mailing Address - Phone:502-753-0680
Mailing Address - Fax:502-753-0687
Practice Address - Street 1:450 EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4204
Practice Address - Country:US
Practice Address - Phone:502-897-3214
Practice Address - Fax:502-897-7685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65901159Medicaid
KY2764Medicare ID - Type Unspecified