Healthcare Provider Details

I. General information

NPI: 1417092958
Provider Name (Legal Business Name): CENTRAL PLAINS RADIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N MAIN
CHENEY KS
67025-0190
US

IV. Provider business mailing address

PO BOX 190
CHENEY KS
67025-0190
US

V. Phone/Fax

Practice location:
  • Phone: 316-542-3400
  • Fax:
Mailing address:
  • Phone: 316-542-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number0103953
License Number StateKS

VIII. Authorized Official

Name: DR. STEVEN J GOULD
Title or Position: CEO
Credential: D.C.
Phone: 316-542-3400