Organization
ST. ELIZABETH PHYSICIANS MAYSVILLE DIAGNOSTIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN LOOMIS (CEO)
(859) 344-3737
Entity
Organization
Contact information
Practice address
910 KENTON STATION DR, SUITE E, MAYSVILLE, KY 41056-9613
(606) 759-0073
(606) 759-0075
Mailing address
2300 CHAMBER CENTER DR, SUITE 200, LAKESIDE PARK, KY 41017-1673
(859) 344-5555
(859) 344-5552
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QR0200X
Radiology Clinic/Center
—
—
293D00000X
Physiological Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100225970
—
KY
Enumeration date
06/14/2012
Last updated
01/13/2015
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