Basic Information
| Provider Information | |||||||||
| NPI: | 1679550784 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ZUBRES RADIOLOGY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 459 | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639020459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732227441 | ||||||||
| FaxNumber: | 5732227479 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 PHYSICIANS PARK | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639013956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737279080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 09/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | ZUBRES | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5732227441 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085U0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | 000015665 | 01 | MEDICARE ID | OTHER | 1198060 | 01 | FIRST HEALTH | OTHER | 242912434 | 05 | MO | MEDICAID | DN3307 | 01 | MO | RAILROAD MEDICARE | OTHER | P00254931 | 01 | MO | RAILROAD MEDICARE | OTHER | 1191801 | 01 | MO | BCBS OF MO | OTHER | 159670003 | 05 | AR | MEDICAID | 211107 | 01 | HEALTHLINK INC | OTHER |