Healthcare Provider Details

I. General information

NPI: 1336101856
Provider Name (Legal Business Name): OZARK MOBILE IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 CHERRY HILL DR SUITE 202E
COLUMBIA MO
65203-5882
US

IV. Provider business mailing address

306 S BELT HWY
SAINT JOSEPH MO
64506-3418
US

V. Phone/Fax

Practice location:
  • Phone: 816-232-2727
  • Fax: 816-232-2771
Mailing address:
  • Phone: 816-232-2727
  • Fax: 816-232-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY B EVANS
Title or Position: MEMBER
Credential:
Phone: 816-232-2727