Healthcare Provider Details

I. General information

NPI: 1316918501
Provider Name (Legal Business Name): STATE LINE IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 STATE LINE RD STE 160
LEAWOOD KS
66206-1569
US

IV. Provider business mailing address

PO BOX 802779
KANSAS CITY MO
64180-0001
US

V. Phone/Fax

Practice location:
  • Phone: 913-648-9500
  • Fax: 913-648-9501
Mailing address:
  • Phone: 913-648-9500
  • Fax: 913-648-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS S SAMUELSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 816-444-9000