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General NPI Number Information
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NPI Number | 1003081530
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Entity Type | Organization
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Legal Business Name | CARTHAGE RADIOLOGOSTS
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 1515 HAZEL ST
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City | CARTHAGE
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State | MO
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Zip | 64836-2850
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Country | US
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Telephone | 417-358-1244
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Fax | 417-358-7157
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Provider Business Mailing Address
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Address Line | PO BOX 871
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City | CARTHAGE
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State | MO
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Zip | 64836-0871
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Country | US
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Telephone | 417-358-1244
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Fax | 417-358-7157
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Authorized Official
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Title or Position | OWNER
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Name | WAYNE E PUTNAM
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Credential | DO
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Telephone | 417-358-1244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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