Healthcare Provider Details

I. General information

NPI: 1437209160
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 N WOODLAWN ST SUITE 350
WICHITA KS
67208-1852
US

IV. Provider business mailing address

2020 N WOODLAWN ST SUITE 350
WICHITA KS
67208-1852
US

V. Phone/Fax

Practice location:
  • Phone: 316-687-1674
  • Fax: 316-687-5788
Mailing address:
  • Phone: 316-687-1674
  • Fax: 316-687-5788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NICHOLAS DEGENNARO
Title or Position: PRESIDENT
Credential:
Phone: 816-853-8667