Provider Demographics
NPI:1952395238
Name:PET CT MANAGEMENT LLC
Entity Type:Organization
Organization Name:PET CT MANAGEMENT LLC
Other - Org Name:BODY SCAN OF LOUISVILLE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-896-7672
Mailing Address - Street 1:7807 SHELBYVILLE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5439
Mailing Address - Country:US
Mailing Address - Phone:502-412-2725
Mailing Address - Fax:502-412-2729
Practice Address - Street 1:7807 SHELBYVILLE RD
Practice Address - Street 2:STE 201
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5439
Practice Address - Country:US
Practice Address - Phone:502-412-2725
Practice Address - Fax:502-412-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000321134OtherANTHEM
KY86000429Medicaid
KY86000429Medicaid
KY9372701Medicare ID - Type Unspecified