Organization
SOMERSET OUTPATIENT DIAGNOSTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA ANN MITCHELL (OFFICE MANAGER)
(606) 678-4114
Entity
Organization
Contact information
Practice address
600 BOGLE ST, SUITE 3, SOMERSET, KY 42503-2885
(606) 678-4114
(606) 679-5862
Mailing address
600 BOGLE ST, SUITE 3, SOMERSET, KY 42503-2885
(606) 678-4114
(606) 679-5862
Taxonomy
Speciality
Code
Description
License number
State
2471M2300X
Mammography Radiologic Technologist
Primary
FDA #169292
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64785512
—
KY
Enumeration date
07/24/2006
Last updated
08/22/2020
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