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General NPI Number Information
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NPI Number | 1770768012
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Entity Type | Organization
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Legal Business Name | MIDWEST RADIOLOGY INSTITUTE
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Dates
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Enumeration Date | 01/06/2008
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 1230 SW HARVEY ST SUITE B
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City | TOPEKA
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State | KS
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Zip | 66604-4069
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Country | US
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Telephone | 785-783-8559
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Fax | 785-783-8562
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Provider Business Mailing Address
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Address Line | 6800 HILLTOP RD SUITE #102
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City | SHAWNEE
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State | KS
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Zip | 66226
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Country | US
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Telephone | 913-745-5300
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Fax | 913-745-5530
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIPP A. VAN CAMP
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Credential | DO
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Telephone | 913-745-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0525311
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License Number State | KS
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