Provider Demographics
NPI:1922097229
Name:KENTUCKY ULTRASOUND ASSOCIATES, INC
Entity Type:Organization
Organization Name:KENTUCKY ULTRASOUND ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-487-1183
Mailing Address - Street 1:609 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1381
Mailing Address - Country:US
Mailing Address - Phone:606-487-1183
Mailing Address - Fax:606-436-0923
Practice Address - Street 1:609 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1381
Practice Address - Country:US
Practice Address - Phone:606-487-1183
Practice Address - Fax:606-436-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY86000163Medicaid
9367001Medicare ID - Type Unspecified