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General NPI Number Information
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NPI Number | 1457417065
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Entity Type | Organization
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Legal Business Name | MEDICAL ARTS DIAGNOSTIC CENTER, LLC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 07/23/2009
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Provider Practice Location Address
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Address Line | 175 SOUTH RANGE SUITE 2
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City | COLBY
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State | KS
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Zip | 67701-0001
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Country | US
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Telephone | 785-462-3332
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Fax | 785-462-3337
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Provider Business Mailing Address
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Address Line | 175 SOUTH RANGE SUITE 2
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City | COLBY
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State | KS
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Zip | 67701-0001
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Country | US
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Telephone | 785-462-3332
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Fax | 785-462-3337
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BRENDA HILDYARD
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Credential |
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Telephone | 785-462-3332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number |
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number |
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License Number State |
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