Provider Demographics
NPI:1013916857
Name:RADIOLOGY AND DIAGNOSTIC IMAGING, PSC
Entity Type:Organization
Organization Name:RADIOLOGY AND DIAGNOSTIC IMAGING, PSC
Other - Org Name:RDI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-926-8171
Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2:BUILDING D
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-926-8171
Mailing Address - Fax:270-926-4574
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BUILDING D
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-926-8171
Practice Address - Fax:270-926-4574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65939407Medicaid
KY000000072893OtherBCBS
KYCB7113OtherRAILROAD MEDICARE
KY3641Medicare ID - Type Unspecified