Provider Demographics
NPI:1780109116
Name:KENTUCKY DIAGNOSTIC ULTRASOUND, LLC
Entity type:Organization
Organization Name:KENTUCKY DIAGNOSTIC ULTRASOUND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT(R)(M),RVT
Authorized Official - Phone:606-219-1074
Mailing Address - Street 1:324 WATER CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-5390
Mailing Address - Country:US
Mailing Address - Phone:606-219-1074
Mailing Address - Fax:606-677-0175
Practice Address - Street 1:324 WATER CLIFF DR.
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503
Practice Address - Country:US
Practice Address - Phone:606-219-1074
Practice Address - Fax:606-677-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY720431335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier