Healthcare Provider Details

I. General information

NPI: 1285883496
Provider Name (Legal Business Name): NOVA RADIOLOGY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-3396
US

IV. Provider business mailing address

4500 S GARNETT RD SUITE 300
TULSA OK
74146-5229
US

V. Phone/Fax

Practice location:
  • Phone: 918-664-9892
  • Fax:
Mailing address:
  • Phone: 918-664-9892
  • Fax: 918-392-2945

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: DR. ALEJANDRO MENDEZ
Title or Position: OWNER
Credential: MD
Phone: 314-780-3388