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Organization

LUNDBERG MEDICAL IMAGING PSC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GERSHOM LUNDBERG (OWNER)
(270) 442-8272
Entity
Organization

Contact information

Practice address
2421 BROADWAY ST, PADUCAH, KY 42001-7115
(270) 442-8272
(270) 444-0539
Mailing address
2421 BROADWAY ST, PADUCAH, KY 42001-7115
(270) 442-8272
(270) 444-0539

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
150821
FDA #
KY
01
150821
FDA NUMBER
01
2398
MEDICARE PTIN
01
4932
BCBS
KY
05
7100152590
KY
Enumeration date
10/17/2006
Last updated
03/26/2015
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