St. Elizabeth Physicians Maysville Diagnostic Center, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

ST. ELIZABETH PHYSICIANS MAYSVILLE DIAGNOSTIC CENTER, LLC

Practice address

910 Kenton Station Dr
Suite E
Maysville, KY 41056-9613

Phone

(606) 759-0073

Fax

(606) 759-0075

NPI assigned

Jun 14, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Glenn Loomis

Title

Ceo

Phone

(859) 344-3737

Specialties & licenses 3

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421107200000",
    "number": "1659633774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 CHAMBER CENTER DR",
            "address_2": "SUITE 200",
            "city": "LAKESIDE PARK",
            "state": "KY",
            "postal_code": "410171673",
            "telephone_number": "859-344-5555",
            "fax_number": "859-344-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 KENTON STATION DR",
            "address_2": "SUITE E",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "410569613",
            "telephone_number": "606-759-0073",
            "fax_number": "606-759-0075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. ELIZABETH PHYSICIANS MAYSVILLE DIAGNOSTIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-14",
        "last_updated": "2015-01-13",
        "status": "A",
        "authorized_official_last_name": "LOOMIS",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "859-344-3737",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100225970",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Dean Spady, M.D.
• Amanda Leah Sparks, LPCC
• Audrey Spencer, MD
• Mark A Spencer, D.C.
• Raghuraman Srinivasan, M.D.
• Linda Stahl, APRN
• Laura L Stamper, APRN
• Courtney Stanton-Shaw, LPCA
• Travis James Stevens, APRN
• Carla Sue Story, APRN

• All providers in Maysville, KY
• Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.