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General NPI Number Information
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NPI Number | 1770458192
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Entity Type | Organization
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Legal Business Name | KINGDOM DIAGNOSTICS LLC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 2022 82ND ST UNIT 101
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City | LUBBOCK
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State | TX
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Zip | 79423-4317
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Country | US
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Telephone | 806-705-7084
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Fax | 806-810-5868
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Provider Business Mailing Address
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Address Line | 1403 11TH PL
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City | SHALLOWATER
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State | TX
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Zip | 79363-5138
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Country | US
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Telephone | 806-705-7084
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Fax | 806-810-5868
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Authorized Official
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Title or Position | OWNER
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Name | PAYON BEAN
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Credential | RVT, RDCS, RMDS, RT
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Telephone | 806-773-1877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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