1679518294 NPI number — ADVANCED MEDICAL IMAGING - HUTCHINSON KS LLC

Table of content: (NPI 1679518294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679518294 NPI number — ADVANCED MEDICAL IMAGING - HUTCHINSON KS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED MEDICAL IMAGING - HUTCHINSON KS 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:
1679518294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 781838
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67278-1838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-502-1209
Provider Business Mailing Address Fax Number:
877-219-2990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1730 E 23RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUTCHINSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67502-1114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-728-1666
Provider Business Practice Location Address Fax Number:
620-728-0205
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURKE
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
316-371-6936

Provider Taxonomy Codes

  • Taxonomy code: 2471M1202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100409360A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110652 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 500458 . This is a "HEALTH PARTNERS OF KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 412980 . This is a "FIRST GUARD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 4994 . This is a "PREFERRED HEALTH SYSTEMS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 470001786 . This is a "PALMETTO" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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