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General NPI Number Information
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NPI Number | 1295089605
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Entity Type | Organization
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Legal Business Name | OZARK REGIONAL VEIN CENTER, LLC
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 5433 W WALSH LN STE 101
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City | ROGERS
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State | AR
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Zip | 72758-8946
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Country | US
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Telephone | 479-464-8346
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 667
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City | WICHITA
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State | KS
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Zip | 67201-0667
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Country | US
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Telephone | 479-464-8346
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RONDALL KEVIN HANEY
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Credential | MD
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Telephone | 479-464-8346
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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 | C-8120
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License Number State | AR
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