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General NPI Number Information
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NPI Number | 1417912221
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Entity Type | Organization
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Legal Business Name | PREMIER PET IMAGING OF WICHITA INC
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 10/02/2007
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Provider Practice Location Address
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Address Line | 500 S MAIN ST SUITE B
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City | WICHITA
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State | KS
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Zip | 67202-3722
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Country | US
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Telephone | 316-263-4738
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Fax | 316-263-6697
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Provider Business Mailing Address
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Address Line | PO BOX 343
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City | WICHITA
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State | KS
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Zip | 67201-0343
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Country | US
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Telephone | 316-262-2015
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Fax | 316-262-0983
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. GEORGE MAHONEY
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Credential |
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Telephone | 561-447-0046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 261Q00000X
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License Number State | KS
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