1104874510 NPI number — HAYSVILLE DIAGNOSTIC CENTER LLC

Table of content: (NPI 1104874510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104874510 NPI number — HAYSVILLE DIAGNOSTIC CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAYSVILLE DIAGNOSTIC CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALLIED MEDICAL IMAGING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104874510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 N. TYLER RD
Provider Second Line Business Mailing Address:
STE. # 114
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-491-2093
Provider Business Mailing Address Fax Number:
316-491-2097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 N TYLER RD
Provider Second Line Business Practice Location Address:
STE. # 114
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67212-4916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-491-2093
Provider Business Practice Location Address Fax Number:
316-491-2097
Provider Enumeration Date:
05/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALVAREZ
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
316-491-2093

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QR0206X , with the licence number: 236167 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 130594 . This is a "BCBS KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 500179 . This is a "HEALTH PARTNERS OF KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 5510599 . This is a "CCN NETWORK" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".