Organization
LUNDBERG MEDICAL IMAGING PSC
Active
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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