Provider Demographics
NPI:1134338874
Name:MEDICAL IMAGING GROUP, LLC
Entity type:Organization
Organization Name:MEDICAL IMAGING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-335-1317
Mailing Address - Street 1:120 SCOTT PERRY DR
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-9000
Mailing Address - Country:US
Mailing Address - Phone:606-789-3815
Mailing Address - Fax:606-789-4815
Practice Address - Street 1:120 SCOTT PERRY DR
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-9000
Practice Address - Country:US
Practice Address - Phone:606-789-3815
Practice Address - Fax:606-789-4815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65942682Medicaid
KY9373501Medicare ID - Type Unspecified