MEDICARE: OZARK MOBILE IMAGING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician
2	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000040062	OTHER	MO	MEDICARE AREA 99
3	388930	OTHER	KS	MEDICARE KS STATEWIDE
5	P00060615	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336101856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OZARK MOBILE IMAGING LLC

Provider Business Mailing Address
First Line	:	306 S BELT HWY
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3418
Country	:	US
Telephone Number	:	816-232-2727
Fax Number	:	816-232-2771

Provider Business Practice Location Address
First Line	:	2012 CHERRY HILL DR
Second Line	:	SUITE 202E
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5882
Country	:	US
Telephone Number	:	816-232-2727
Fax Number	:	816-232-2771

Authorized Official
Title or Position	:	MEMBER
Name	:	ZACHARY B EVANS
Credential	:
Telephone Number	:	816-232-2727

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	08/31/2011

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Directions to “OZARK MOBILE IMAGING LLC ” Practice Location

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