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General NPI Number Information
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NPI Number | 1043392665
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Entity Type | Organization
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Legal Business Name | GLEASON DIAGNOSTIC IMAGING, PC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1015 UNION ST
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City | BOONE
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State | IA
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Zip | 50036-4821
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Country | US
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Telephone | 515-432-3140
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Fax | 515-433-8916
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Provider Business Mailing Address
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Address Line | PO BOX 2085
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City | SIOUX CITY
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State | IA
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Zip | 51104-0085
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Country | US
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Telephone | 515-230-3363
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Fax | 712-239-3711
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Authorized Official
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Title or Position | MANAGER
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Name | GREG A HAAR
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Credential |
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Telephone | 515-230-3363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2676
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License Number State | IA
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