Provider Demographics
NPI:1679549976
Name:WESTERN KENTUCKY DIAGNOSTIC IMAGING, PSC
Entity type:Organization
Organization Name:WESTERN KENTUCKY DIAGNOSTIC IMAGING, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:VEITSCHEGGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:270-746-9500
Mailing Address - Street 1:1635 SCOTTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3244
Mailing Address - Country:US
Mailing Address - Phone:270-746-9500
Mailing Address - Fax:270-901-2155
Practice Address - Street 1:1635 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3244
Practice Address - Country:US
Practice Address - Phone:270-746-9500
Practice Address - Fax:270-901-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY202-236-25174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65926792Medicaid
KY65926792Medicaid