Provider Demographics
NPI:1730159435
Name:PHYSICIANS IMAGING PSC
Entity type:Organization
Organization Name:PHYSICIANS IMAGING PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-368-9451
Mailing Address - Street 1:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1006
Mailing Address - Country:US
Mailing Address - Phone:866-494-8267
Mailing Address - Fax:
Practice Address - Street 1:2483 HIGHWAY
Practice Address - Street 2:644
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230
Practice Address - Country:US
Practice Address - Phone:606-638-9451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2628973Medicaid
OH2633207Medicaid
OH2642742Medicaid
KY000000369658OtherANTHEM
WV3810004587Medicaid
OH000000369658OtherATHEM
WV3810004784Medicaid
WV001799254OtherMSBCBS
KY65944258Medicaid
WV3810004359Medicaid
WV3810004587Medicaid
OH2628973Medicaid
KY65944258Medicaid