Healthcare Provider Details

I. General information

NPI: 1003315359
Provider Name (Legal Business Name): AFFORDABLE MOBILE DIAGNOSTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 E CENTRAL AVE STE 208
WICHITA KS
67206-1924
US

IV. Provider business mailing address

6505 E CENTRAL AVE STE 208
WICHITA KS
67206-1924
US

V. Phone/Fax

Practice location:
  • Phone: 316-619-4507
  • Fax:
Mailing address:
  • Phone: 316-619-4507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number22-03280
License Number StateKS

VIII. Authorized Official

Name: ELIAS BERNARD
Title or Position: PRESIDENT
Credential: ARRT
Phone: 316-619-4507