Healthcare Provider Details

I. General information

NPI: 1215997002
Provider Name (Legal Business Name): AREA RADIOLOGICAL CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N WALNUT ST
MEDICINE LODGE KS
67104-1019
US

IV. Provider business mailing address

PO BOX 2189
PONCA CITY OK
74602-2189
US

V. Phone/Fax

Practice location:
  • Phone: 972-526-0340
  • Fax: 972-996-1857
Mailing address:
  • Phone: 972-526-0340
  • Fax: 972-996-1857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN L COYNER
Title or Position: OWNER
Credential: MD
Phone: 972-526-0342