Provider Demographics
NPI:1871706531
Name:SAFEGUARD RADIOLOGY INTERPRETATION SERVICES LLC
Entity type:Organization
Organization Name:SAFEGUARD RADIOLOGY INTERPRETATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAJESKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-387-5133
Mailing Address - Street 1:9462 BROWNSBORO RD # 268
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-1118
Mailing Address - Country:US
Mailing Address - Phone:502-961-0111
Mailing Address - Fax:502-427-7797
Practice Address - Street 1:6304 THOMAS CT
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-7515
Practice Address - Country:US
Practice Address - Phone:502-961-0011
Practice Address - Fax:502-213-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4777111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85002913Medicaid
KY85002913Medicaid
KYU97916Medicare UPIN