Provider Demographics
| NPI: | 1053782482 |
|---|---|
| Name: | TACKETT-HOLSCHUH RADIOLOGY, INC |
| Entity type: | Organization |
| Organization Name: | TACKETT-HOLSCHUH RADIOLOGY, INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER/PRESIDENT |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | DONALD |
| Authorized Official - Middle Name: | R |
| Authorized Official - Last Name: | TACKETT |
| Authorized Official - Suffix: | JR |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 606-237-6300 |
| Mailing Address - Street 1: | 411 CENTRAL AVENUE |
| Mailing Address - Street 2: | SUITE 1 |
| Mailing Address - City: | SOUTH WILLIAMSON |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 41503 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 606-237-6300 |
| Mailing Address - Fax: | 606-237-7444 |
| Practice Address - Street 1: | 411 CENTRAL AVENUE |
| Practice Address - Street 2: | SUITE 1 |
| Practice Address - City: | SOUTH WILLIAMSON |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 41503 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 606-237-6300 |
| Practice Address - Fax: | 606-237-7444 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2015-10-12 |
| Last Update Date: | 2015-10-12 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM1200X | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) | Group - Multi-Specialty |
| No | 2085D0003X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | Group - Multi-Specialty |
| No | 247100000X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Group - Multi-Specialty | |
| No | 2471B0102X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Bone Densitometry | Group - Multi-Specialty |
| No | 2471C3401X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Computed Tomography | Group - Multi-Specialty |
| No | 2471M1202X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Magnetic Resonance Imaging | Group - Multi-Specialty |
| No | 2471M2300X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Mammography | Group - Multi-Specialty |
| No | 2471S1302X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Sonography | Group - Multi-Specialty |
| No | 2471V0105X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Vascular Sonography | Group - Multi-Specialty |
