Professional Park Diagnostics PLLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

PROFESSIONAL PARK DIAGNOSTICS PLLC

Practice address

3346 Professional Park
Suite a
Owensboro, KY 42303-4551

Phone

(270) 228-0405

Fax

(270) 852-8924

NPI assigned

Oct 8, 2020

Organization subpart

No

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

Authorized official

Name

Debra T Mattingly

Title

Credentialing Manager

Phone

(270) 852-8931

Specialties & licenses 1

Addresses

Other names 1

• Professional Park Diagnostics PLLC, , Radiology Doing business as

Locations

Practitioners 1

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

• David Joseph Johnson, M.D.

  • Internal Medicine Physician
  • Owensboro, KY
  • NPI 1215933247
  NPD (past)

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

{
    "created_epoch": "1602115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1902403264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3346 PROFESSIONAL PARK",
            "address_2": "SUITE A",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423034551",
            "telephone_number": "270-852-8931",
            "fax_number": "270-852-8924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3346 PROFESSIONAL PARK",
            "address_2": "SUITE A",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423034551",
            "telephone_number": "270-228-0405",
            "fax_number": "270-852-8924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PARK DIAGNOSTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-08",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "MATTINGLY",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "270-852-8931"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Park Diagnostics PLLC, , Radiology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Professional Park Diagnostics PLLC, , Radiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Micah Ashley Price, APRN
• Primary Care Solutions, LLC
• Primary Care Solutions, LLC
• John Russell Prine, PHARM.D., RPH
• Professional Park Diagnostics PLLC
• Progressive Rehab, Inc.
• Progressive Sports Therapy, LLC.
• Progressive Sports Therapy, LLC.
• Progressive Therapy and Wellness
• Prorehab, Inc

• All providers in Owensboro, KY
• Radiology Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; 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.