Provider Demographics
NPI:1700976743
Name:RADIOLOGY PSC
Entity Type:Organization
Organization Name:RADIOLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:PAIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-685-5165
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-0807
Mailing Address - Country:US
Mailing Address - Phone:270-685-5165
Mailing Address - Fax:270-683-0256
Practice Address - Street 1:811 E PARRISH AVE
Practice Address - Street 2:OWENSBORO MEDIAL HEALTH SYSTEMS
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-685-5165
Practice Address - Fax:270-683-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
15B8OtherBCBS
KY65909178Medicaid
KY0461Medicare ID - Type Unspecified