Healthcare Provider Details

I. General information

NPI: 1629230826
Provider Name (Legal Business Name): LIONHEART HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 06/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 S BUSINESS HIGHWAY 65
HOLLISTER MO
65672-5105
US

IV. Provider business mailing address

2331 S BUSINESS HIGHWAY 65
HOLLISTER MO
65672-5105
US

V. Phone/Fax

Practice location:
  • Phone: 417-337-4802
  • Fax: 417-339-9133
Mailing address:
  • Phone: 417-337-4802
  • Fax: 417-339-9133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD RANDALL SUKMAN
Title or Position: OWNER
Credential: MD
Phone: 417-337-4802