Organization
DIAGNOSTIC RADIOLOGY OF LONDON PSC
Active
Organization
DIAGNOSTIC RADIOLOGY OF LONDON PSC
Active
Other names
Advanced Imaging and Open MRI
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY JO SHRUM (FACILITY DIRECTOR)
(606) 340-0009
Entity
Organization
Contact information
Practice address
75 WALMART PLAZA DR UNIT 4, MONTICELLO, KY 42633-7907
(606) 340-0009
(606) 340-0113
Mailing address
75 WALMART PLAZA DR UNIT 4, MONTICELLO, KY 42633-7907
(606) 340-0009
(606) 340-0113
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
33556
KY
261QR0200X
Radiology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64353568
—
KY
01
—
DQ4251
RAILROAD MEDICARE
KY
Enumeration date
09/21/2006
Last updated
08/02/2013
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