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General NPI Number Information
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NPI Number | 1083675227
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Entity Type | Organization
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Legal Business Name | WALNUT VALLEY IMAGING PA
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 817 MAIN ST
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City | WINFIELD
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State | KS
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Zip | 67156-2834
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Country | US
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Telephone | 620-441-5788
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 47309
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City | WICHITA
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State | KS
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Zip | 67201-7309
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Country | US
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Telephone | 316-685-8428
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NEIL ROSENQUIST
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Credential | MD
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Telephone | 620-441-5788
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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 | 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 #3
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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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