=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376528521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HELENA RADIOLOGY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2005
-----------------------------------------------------
Last Update Date | 03/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 MARTIN LUTHER KING JR DR
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72342-8998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-338-5800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1547
-----------------------------------------------------
City | SEDALIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65302-1547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-826-5960
-----------------------------------------------------
Fax | 660-826-4852
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SANDRA KOCHANSKI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 870-338-5800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------