Healthcare Provider Details

I. General information

NPI: 1932548864
Provider Name (Legal Business Name): PITTSBURG IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N PINE ST
PITTSBURG KS
66762-4743
US

IV. Provider business mailing address

PO BOX 1539
PITTSBURG KS
66762-1539
US

V. Phone/Fax

Practice location:
  • Phone: 620-231-9072
  • Fax:
Mailing address:
  • Phone: 620-231-9072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN PATTERSON
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 620-231-9070