Provider Demographics
NPI:1922035443
Name:DOWNTOWN RADIOLOGY INC
Entity Type:Organization
Organization Name:DOWNTOWN RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:606-248-3171
Mailing Address - Street 1:123 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2865
Mailing Address - Country:US
Mailing Address - Phone:606-248-3171
Mailing Address - Fax:606-248-3206
Practice Address - Street 1:123 N. 19TH ST.
Practice Address - Street 2:123 N. 19TH ST.
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-4623
Practice Address - Country:US
Practice Address - Phone:606-248-3171
Practice Address - Fax:606-248-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7300192471C3402X
KY2695702471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
Not Answered2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY292804OtherBLACK LUNG PROGRAM
KY885OtherCHA INSURANCE
KY86010071Medicaid
KY885OtherBLUEGRASS FAMILY HLTH
KY885OtherACORDIA INS
KY000000073139OtherB/C B/SHIELD OF KY #
KY000816234002OtherUNITED HEALTHCARE
KY1403954OtherUMWA INS
KY7144OtherCHA INSURANCE
KY885OtherBLUEGRASS FAMILY HLTH
KY000000073139OtherB/C B/SHIELD OF KY #
KY885OtherBLUEGRASS FAMILY HLTH