Provider Demographics
NPI:1447259197
Name:MAYSVILLE RADIOLOGY ASSOCIATES, PSC
Entity type:Organization
Organization Name:MAYSVILLE RADIOLOGY ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-759-3130
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-0813
Mailing Address - Country:US
Mailing Address - Phone:606-759-3130
Mailing Address - Fax:502-223-9829
Practice Address - Street 1:989 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-8750
Practice Address - Country:US
Practice Address - Phone:606-759-3130
Practice Address - Fax:502-223-9829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY192172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000058821OtherANTHEM BC/BS PIN
KY64192172Medicaid
KYC74139OtherBLUEGRASS FAMILY HEALTH
KY8759011OtherUNITED HEALTHCARE PIN
KY000000058821OtherANTHEM BC/BS PIN