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General NPI Number Information
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NPI Number | 1316059819
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL RADIOLOGY SERVICES, P.A.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 2004 1ST AVE STE A
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City | DODGE CITY
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State | KS
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Zip | 67801-2697
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Country | US
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Telephone | 620-225-1033
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Fax | 620-227-8491
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Provider Business Mailing Address
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Address Line | 2004 1ST AVE STE A
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City | DODGE CITY
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State | KS
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Zip | 67801-2697
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Country | US
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Telephone | 620-225-1033
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Fax | 620-227-8491
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES E NIXON
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Credential | MD
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Telephone | 620-225-1033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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