Provider Demographics
NPI:1730224817
Name:GLASGOW RADIOLOGY, PSC
Entity type:Organization
Organization Name:GLASGOW RADIOLOGY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHADOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-651-9129
Mailing Address - Street 1:PO BOX 1537
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42142-1537
Mailing Address - Country:US
Mailing Address - Phone:270-651-9129
Mailing Address - Fax:270-651-4916
Practice Address - Street 1:106 E WAYNE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2636
Practice Address - Country:US
Practice Address - Phone:270-651-9129
Practice Address - Fax:270-651-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000057712OtherANTHEM GROUP
KY65906059Medicaid
KY0447Medicare ID - Type UnspecifiedMEDICARE GROUP