Provider Demographics
NPI:1972657104
Name:PROSCAN IMAGING OF LOUISVILLE LLC
Entity Type:Organization
Organization Name:PROSCAN IMAGING OF LOUISVILLE LLC
Other - Org Name:PROSCAN IMAGING ST MATTHEWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:AMAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-924-5174
Mailing Address - Street 1:4044 DUTCHMANS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4712
Mailing Address - Country:US
Mailing Address - Phone:502-491-1313
Mailing Address - Fax:502-491-1315
Practice Address - Street 1:4044 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4712
Practice Address - Country:US
Practice Address - Phone:502-491-1313
Practice Address - Fax:502-491-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9382601Medicare PIN