Basic Information
| Provider Information | |||||||||
| NPI: | 1396411559 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL IMAGING KANSAS CITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 S NEW BALLAS RD LBBY 5 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631418721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143243728 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 E ARMOUR BLVD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641111201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9999999999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2021 | ||||||||
| LastUpdateDate: | 08/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | BROOKS | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3143243728 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 08/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
ID Information
| ID | Type | State | Issuer | Description | 2085B0100X | 01 | MO | RADIOLOGY- BODY IMAGING | OTHER | 2085R0202X | 01 | MO | RADIOLOGY- DIAGNOSTIC RADIOLOGY | OTHER |