Healthcare Provider Details

I. General information

NPI: 1609012145
Provider Name (Legal Business Name): KFL RADIOLOGY PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 RIVER FOREST CT
FORT DODGE IA
50501-7019
US

IV. Provider business mailing address

PO BOX 2660
WATERLOO IA
50704-2660
US

V. Phone/Fax

Practice location:
  • Phone: 515-955-5515
  • Fax:
Mailing address:
  • Phone: 319-233-3044
  • Fax: 319-233-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KEITH F LACEY
Title or Position: OWNER
Credential: MD
Phone: 319-233-3044