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General NPI Number Information
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NPI Number | 1568183499
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Entity Type | Organization
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Legal Business Name | SPENCER IMAGING CENTER, LLC
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Dates
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Enumeration Date | 09/08/2022
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 710 S. GRAND AVE
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City | SPENCER
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State | IA
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Zip | 51301
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Country | US
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Telephone | 712-580-5074
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Fax | 712-580-5076
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Provider Business Mailing Address
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Address Line | 710 S. GRAND AVE
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City | SPENCER
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State | IA
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Zip | 51301-5730
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Country | US
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Telephone | 712-580-5074
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Fax | 712-580-5076
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | ALEXANDER PRUITT
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Credential | MD
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Telephone | 712-260-7513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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