Healthcare Provider Details

I. General information

NPI: 1083675227
Provider Name (Legal Business Name): WALNUT VALLEY IMAGING PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 MAIN ST
WINFIELD KS
67156-2834
US

IV. Provider business mailing address

PO BOX 47309
WICHITA KS
67201-7309
US

V. Phone/Fax

Practice location:
  • Phone: 620-441-5788
  • Fax:
Mailing address:
  • Phone: 316-685-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: NEIL ROSENQUIST
Title or Position: PRESIDENT
Credential: MD
Phone: 620-441-5788