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General NPI Number Information
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NPI Number | 1043005606
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Entity Type | Organization
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Legal Business Name | PHS KS MOIRAI LLC
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 1510 WALNUT ST
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City | COFFEYVILLE
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State | KS
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Zip | 67337-6641
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Country | US
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Telephone | 918-504-1659
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Fax |
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Provider Business Mailing Address
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Address Line | 6943 S JAMESTOWN AVE
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City | TULSA
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State | OK
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Zip | 74136-2611
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Country | US
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Telephone | 918-504-1659
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JAMES AARON BAKER
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Credential |
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Telephone | 918-504-1659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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