Healthcare Provider Details

I. General information

NPI: 1871643601
Provider Name (Legal Business Name): MARSHALL RADIOLOGY SERVICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 S HIGHWAY 65
MARSHALL MO
65340-3702
US

IV. Provider business mailing address

PO BOX 1547
SEDALIA MO
65302-1547
US

V. Phone/Fax

Practice location:
  • Phone: 660-831-3286
  • Fax:
Mailing address:
  • Phone: 660-826-5960
  • Fax: 660-826-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: NORBERTO RESTITUTO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 660-831-3286