MEDICARE: DIAGNOSTIC RADIOLOGY INSTITUTE OF KANSAS CITY, 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
1	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1669464426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC RADIOLOGY INSTITUTE OF KANSAS CITY, INC.

Provider Business Mailing Address
First Line	:	6444 METCALF AVE
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66202-3950
Country	:	US
Telephone Number	:	913-831-0509
Fax Number	:	913-831-0439

Provider Business Practice Location Address
First Line	:	6444 METCALF AVE
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66202-3950
Country	:	US
Telephone Number	:	913-831-0509
Fax Number	:	913-831-0439

Authorized Official
Title or Position	:	FACILITY MANAGER
Name	:	KATHY BERWANGER
Credential	:
Telephone Number	:	913-831-0509

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	08/22/2020

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