Provider Demographics
NPI:1962628727
Name:CENTRAL PHYSICIANS IMAGING
Entity Type:Organization
Organization Name:CENTRAL PHYSICIANS IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:TUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-260-7037
Mailing Address - Street 1:PO BOX 910964
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0964
Mailing Address - Country:US
Mailing Address - Phone:859-260-7025
Mailing Address - Fax:
Practice Address - Street 1:100 SOUTHLAND DR
Practice Address - Street 2:SUITE B
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1927
Practice Address - Country:US
Practice Address - Phone:859-260-7025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY730092261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY86000478Medicaid
KY9375001Medicare ID - Type Unspecified