Maysville Diagnostic Center LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

730123 Issued in KY

Legal business name

MAYSVILLE DIAGNOSTIC CENTER LLC

Practice address

910 Kenton Station Dr
Suite E
Maysville, KY 41056-9658

Phone

(606) 759-0073

Fax

(606) 759-0075

NPI assigned

Apr 4, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Donna Ishmael

Title

Chief Operating Officer

Phone

(606) 759-0073

Specialties & licenses 3

Addresses

Other identifiers 3

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Maysville Diagnostic Center Sleep Lab

  • Sleep Disorder Diagnostic Clinic/Center
  • Maysville, KY
  • NPI 1922269224
  NPPES parent name

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240876800000",
    "number": "1952423691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 KENTON STATION DR",
            "address_2": "SUITE E",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "410569658",
            "telephone_number": "606-759-0073",
            "fax_number": "606-759-0075"
        },
        {
            "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": "410569658",
            "telephone_number": "606-759-0073",
            "fax_number": "606-759-0075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYSVILLE DIAGNOSTIC CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2009-04-28",
        "status": "A",
        "authorized_official_last_name": "ISHMAEL",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "606-759-0073",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "KY",
            "license": "730123",
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "KY",
            "license": "730123",
            "primary": false
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": "KY",
            "license": "730122",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100029410",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00458422",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000555492",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maverick Optical LLC
• Jeffrey Allen Maves, CRNA
• Allen Mayberry, TCM
• Mary Elizabeth Mayhall
• Melinda Galliher Mays, LPCC
• Maysville Diagnostic Center Sleep Lab
• Maysville Foot & Ankle Clinic
• Maysville Foot & Ankle Clinic
• Maysville Internal Medicine Pediatric Assoc PSC
• Maysville Manor LLC

• Clinic/Center in Maysville, KY
• Providers in Maysville, KY by specialty
• Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2009; 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.