Healthcare Provider Details

I. General information

NPI: 1245208008
Provider Name (Legal Business Name): PRAIRIE CREEK IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S MAIN ST
WICHITA KS
67202-3722
US

IV. Provider business mailing address

PO BOX 2854
WICHITA KS
67201-2854
US

V. Phone/Fax

Practice location:
  • Phone: 316-262-1103
  • Fax:
Mailing address:
  • Phone: 316-685-3698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GLEN SHURTZ
Title or Position: PRESIDENT
Credential: MD
Phone: 316-262-1103