Basic Information
| Provider Information | |||||||||
| NPI: | 1477877504 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHERIDAN RADIOLOGY SERVICES OF KENTUCKY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 452228 | ||||||||
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| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333452228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548382371 | ||||||||
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| Practice Location | |||||||||
| Address1: | 260 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH WILLIAMSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415034072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062371700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2010 | ||||||||
| LastUpdateDate: | 07/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | DROZDOW | ||||||||
| AuthorizedOfficialFirstName: | GILBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9548382371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.