Provider Demographics
NPI:1295721454
Name:RADIOLOGY GROUP OF PADUCAH PSC
Entity type:Organization
Organization Name:RADIOLOGY GROUP OF PADUCAH PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:HALFHILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-564-3073
Mailing Address - Street 1:PO BOX 631771
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1771
Mailing Address - Country:US
Mailing Address - Phone:270-575-2100
Mailing Address - Fax:812-471-6650
Practice Address - Street 1:2501 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3813
Practice Address - Country:US
Practice Address - Phone:270-575-2100
Practice Address - Fax:812-471-6650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100252480Medicaid
KY7100252480Medicaid
KY65911026Medicaid
KY8679Medicare ID - Type Unspecified