Provider Demographics
NPI:1205080082
Name:EBO MRI, LLC
Entity type:Organization
Organization Name:EBO MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-587-9581
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-587-1236
Mailing Address - Fax:502-587-0318
Practice Address - Street 1:13151 MAGISTERIAL DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4103
Practice Address - Country:US
Practice Address - Phone:502-587-1236
Practice Address - Fax:502-587-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY=========OtherTAX ID