Healthcare Provider Details

I. General information

NPI: 1467637769
Provider Name (Legal Business Name): HUBLALL RADIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 W 32ND ST
JOPLIN MO
64804-1529
US

IV. Provider business mailing address

PO BOX 25673
OVERLAND PARK KS
66225-5673
US

V. Phone/Fax

Practice location:
  • Phone: 417-626-0072
  • Fax: 417-626-0919
Mailing address:
  • Phone: 913-825-0896
  • Fax: 913-825-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number200401951
License Number StateMO

VIII. Authorized Official

Name: DR. RONALD V HUBLALL
Title or Position: OWNER/RADIOLOGIST
Credential: MD
Phone: 913-825-0896