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General NPI Number Information
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NPI Number | 1265786305
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Entity Type | Organization
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Legal Business Name | PROWAVE DIAGNOSTICS LLC
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Dates
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Enumeration Date | 10/27/2012
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Last Update Date | 10/27/2012
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Provider Practice Location Address
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Address Line | 238 PEACH LN
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City | RIDGEDALE
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State | MO
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Zip | 65739-4182
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Country | US
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Telephone | 831-477-6633
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 130
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City | RIDGEDALE
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State | MO
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Zip | 65739-0130
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | STEPHANIE CONGER
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Credential |
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Telephone | 615-419-3375
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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 | MO
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