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NPI Code Detail

MEDICARE: NEVADA IMAGING INC

MEDICARE: NEVADA IMAGING INC
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
12085R0202XDiagnostic Radiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
122965012OTHERMOBCBS

General Provider Information

NPI Number : 1497730576
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEVADA IMAGING INC
Provider Business Mailing Address
First Line : PO BOX 1547
Second Line :
City : SEDALIA
State : MO
Zip : 65302-1547
Country : US
Telephone Number : 660-826-5960
Fax Number : 660-826-4852
Provider Business Practice Location Address
First Line : 800 S ASH ST
Second Line :
City : NEVADA
State : MO
Zip : 64772-3223
Country : US
Telephone Number : 417-667-3355
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MICHAEL T MOORE
Credential : MD
Telephone Number : 417-667-3355
Provider Enumeration Date : 12/12/2005
Last Update Date : 03/11/2008

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Directions to “NEVADA IMAGING INC ” Practice Location

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