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General NPI Number Information
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NPI Number | 1477733418
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Entity Type | Organization
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Legal Business Name | PK XRAY, INC
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 3379A GREEN ACRES RD
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City | SPRINGDALE
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State | AR
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Zip | 72764-0236
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Country | US
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Telephone | 918-683-9729
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Fax | 918-683-1012
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Provider Business Mailing Address
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Address Line | 347 S 37TH ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-4906
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Country | US
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Telephone | 918-683-9729
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Fax | 918-683-1012
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PHILLIPS LEE KIZZIA
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Credential |
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Telephone | 918-683-9729
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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 | RT1299
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License Number State | AR
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