Provider Demographics
NPI:1962492066
Name:NORTHEAST KENTUCKY IMAGING INC
Entity Type:Organization
Organization Name:NORTHEAST KENTUCKY IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEGIORGIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-286-5888
Mailing Address - Street 1:PO BOX M
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-0510
Mailing Address - Country:US
Mailing Address - Phone:866-286-5888
Mailing Address - Fax:
Practice Address - Street 1:1000 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7034
Practice Address - Country:US
Practice Address - Phone:606-833-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65908204Medicaid
WV0202995000Medicaid
OH2610786Medicaid
WV3810004299Medicaid
WV3810004361Medicaid
OH2610777Medicaid
WV3810004300Medicaid
WV3810004320Medicaid
WV3810004338Medicaid
OH2610811Medicaid
OH2610857Medicaid
WV3810004362Medicaid
OH0524696Medicaid
OH2610802Medicaid
OH2610839Medicaid
KY000000063419OtherBCBS
OH2610820Medicaid
WV3810004321Medicaid
OH2610802Medicaid
OH2610811Medicaid