Provider Demographics
NPI:1174526982
Name:HORSLEY, PSC
Entity type:Organization
Organization Name:HORSLEY, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-403-1401
Mailing Address - Street 1:611 HAMMOND PLZ
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-4971
Mailing Address - Country:US
Mailing Address - Phone:270-885-1950
Mailing Address - Fax:270-885-4431
Practice Address - Street 1:611 HAMMOND PLZ
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4971
Practice Address - Country:US
Practice Address - Phone:270-885-1950
Practice Address - Fax:270-885-4431
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HORSLEY, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-24
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY300102264OtherMEDICARE RR
TN1518114Medicaid
KY64230873Medicaid
KY300102264OtherMEDICARE RR