Healthcare Provider Details

I. General information

NPI: 1851476436
Provider Name (Legal Business Name): RADIOLOGY SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W LEOTA ST
NORTH PLATTE NE
69101-6525
US

IV. Provider business mailing address

PO BOX 362
NORTH PLATTE NE
69103-0362
US

V. Phone/Fax

Practice location:
  • Phone: 308-647-6444
  • Fax:
Mailing address:
  • Phone: 308-647-6444
  • Fax: 308-647-6433

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: TAMARA S HLAVATY
Title or Position: OWNER
Credential: MD
Phone: 308-647-6444