Healthcare Provider Details

I. General information

NPI: 1720923311
Provider Name (Legal Business Name): PHS MO ANANKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 W 32ND ST # 208A
JOPLIN MO
64804-1611
US

IV. Provider business mailing address

8181 E 46TH ST
TULSA OK
74145-4801
US

V. Phone/Fax

Practice location:
  • Phone: 800-771-9729
  • Fax:
Mailing address:
  • Phone: 918-664-9729
  • Fax:

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: JAMES BAKER
Title or Position: CEO
Credential:
Phone: 918-664-9729