| Organization Name: | SOURCE DIAGNOSTICS OF KENTUCKY, LLC |
| NPI Number: | 1629339171 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATHLEEN A BARRY (COO) |
| Mailing Address: | 534 Enterprise Dr Erlanger |
| State: | KY US |
| Postal Code: | 410171526 |
| Phone Number: | 8665121515 |
| Fax Number: | |
| NPI Enumeration Date: | 05/31/2012 |
| NPI Last Update Date: | 05/31/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0208X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology, Mobile |
| Taxonomy Definition: | |