Provider Demographics
NPI:1184092009
Name:MOBILE IMAGES OF KENTUCKY LLC
Entity type:Organization
Organization Name:MOBILE IMAGES OF KENTUCKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-667-4691
Mailing Address - Street 1:517 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1475
Mailing Address - Country:US
Mailing Address - Phone:800-232-5756
Mailing Address - Fax:888-405-0653
Practice Address - Street 1:517 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1475
Practice Address - Country:US
Practice Address - Phone:800-232-5756
Practice Address - Fax:888-405-0653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYK193520335V00000X
KY335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK193520Medicaid