1336101856 NPI number — OZARK MOBILE IMAGING LLC

Table of content: (NPI 1336101856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336101856 NPI number — OZARK MOBILE IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OZARK MOBILE IMAGING 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:
Provider Other Organization Name Type Code:
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:
1336101856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 S BELT HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOSEPH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64506-3418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-232-2727
Provider Business Mailing Address Fax Number:
816-232-2771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2012 CHERRY HILL DR
Provider Second Line Business Practice Location Address:
SUITE 202E
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65203-5882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-232-2727
Provider Business Practice Location Address Fax Number:
816-232-2771
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
ZACHARY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
816-232-2727

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 716090808 . This is a "MEDICAID" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000040062 . This is a "MEDICARE AREA 99" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 388930 . This is a "MEDICARE KS STATEWIDE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200347870 . This is a "MEDICAID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: P00060615 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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