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General NPI Number Information
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NPI Number | 1376507590
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Entity Type | Organization
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Legal Business Name | LINE DIAGNOSTICS INC
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 630 S HILLSIDE ST
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City | WICHITA
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State | KS
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Zip | 67211-2157
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Country | US
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Telephone | 316-491-5926
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Fax | 316-491-5962
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Provider Business Mailing Address
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Address Line | PO BOX 47259
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City | WICHITA
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State | KS
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Zip | 67201
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Country | US
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Telephone | 316-491-5926
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Fax | 316-491-5962
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. LYLE F ZEPICK
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Credential | MD
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Telephone | 316-491-5926
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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 |
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License Number State |
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