Organization
MAYSVILLE DIAGNOSTIC CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONNA ISHMAEL (CHIEF OPERATING OFFICER)
(606) 759-0073
Entity
Organization
Contact information
Practice address
910 KENTON STATION DR, SUITE E, MAYSVILLE, KY 41056-9658
(606) 759-0073
(606) 759-0075
Mailing address
910 KENTON STATION DR, SUITE E, MAYSVILLE, KY 41056-9658
(606) 759-0073
(606) 759-0075
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
730123
KY
261QR0200X
Radiology Clinic/Center
730123
KY
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
730122
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000555492
ANTHEM
KY
05
—
7100029410
—
KY
01
—
P00458422
RR MEDICARE
KY
Enumeration date
04/04/2007
Last updated
04/28/2009
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