Provider Demographics
NPI:1780870378
Name:VIVID DIAGNOSTIC
Entity type:Organization
Organization Name:VIVID DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-436-0440
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0276
Mailing Address - Country:US
Mailing Address - Phone:606-436-0440
Mailing Address - Fax:
Practice Address - Street 1:132 GRAND VUE PLZ
Practice Address - Street 2:UNIT 6
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-6842
Practice Address - Country:US
Practice Address - Phone:606-436-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty