Provider Demographics
NPI:1245368125
Name:NARRA RADIOLOGY INC.
Entity type:Organization
Organization Name:NARRA RADIOLOGY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAPUJI
Authorized Official - Middle Name:
Authorized Official - Last Name:NARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-237-6300
Mailing Address - Street 1:411 CENTRAL AVE
Mailing Address - Street 2:#1
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4149
Mailing Address - Country:US
Mailing Address - Phone:606-237-6300
Mailing Address - Fax:606-237-7444
Practice Address - Street 1:411 CENTRAL AVE
Practice Address - Street 2:#1
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4149
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:2007-03-01
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY216562085R0202X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1025204OtherWV COMP
WV1045897OtherCAMBRIDGE
KY65932956Medicaid
300097776OtherRR MEDICARE
65036OtherANTHEM
KY65041OtherBC/BS
02772OtherAETNA NETWORK ID
KY64216567Medicaid
1788001Medicare Oscar/Certification
KY64216567Medicaid
KY65932956Medicaid