Organization Active NPI

Lifescan Imaging, LLC

  • Radiology Clinic/Center
  • Somerset, KY
National Provider Identifier
1780687798
Registry record updated Jan 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
LIFESCAN IMAGING, LLC
Practice address
607 Clifty St
Ste 102
Somerset, KY 42503-1765
Phone
(606) 677-6664
Fax
(606) 677-6560
NPI assigned
May 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2010

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

Authorized official

Name
Mrs. Michelle Douglas
Title
Credentialing Manager
Phone
(502) 403-1401

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

607 Clifty St
Ste 102
Somerset, KY 42503-1765

Mailing address

607 Clifty St
Ste 102
Somerset, KY 42503-1765
Phone (606) 677-6664

Other identifiers 2

IdentifierTypeStateIssuer
7100090800MedicaidKY
65940322MedicaidKY

National Provider Directory

National Provider Directory

Locations

607 Clifty St
Ste 102
Somerset, KY 42503
Phone (606) 677-6664

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264550400000",
    "number": "1780687798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 CLIFTY ST",
            "address_2": "STE 102",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425031765",
            "telephone_number": "606-677-6664",
            "fax_number": "606-677-6560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 CLIFTY ST",
            "address_2": "STE 102",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425031765",
            "telephone_number": "606-677-6664",
            "fax_number": "606-677-6560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESCAN IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2010-01-27",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "502-403-1401",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100090800",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65940322",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerset, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2010; 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.