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General NPI Number Information
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NPI Number | 1720081524
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Entity Type | Organization
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Legal Business Name | MIDWEST RADIOLOGY AND IMAGING PC
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 1200 1ST AVE E
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City | SPENCER
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State | IA
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Zip | 51301-4342
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Country | US
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Telephone | 712-262-7511
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Fax | 712-262-3658
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Provider Business Mailing Address
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Address Line | 1200 1ST AVE E
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City | SPENCER
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State | IA
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Zip | 51301-4342
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Country | US
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Telephone | 712-262-7511
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Fax | 712-262-3658
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. CHARLES ALLEN CROUCH
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Credential | M.D.
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Telephone | 712-262-7511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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