Basic Information
| Provider Information | |||||||||
| NPI: | 1689636243 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRESCOTT RADIOLOGISTS LLP | ||||||||
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| OtherOrganizationName: | PRESCOTT IMAGING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 678308 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 752678308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284452700 | ||||||||
| FaxNumber: | 8006560593 | ||||||||
| Practice Location | |||||||||
| Address1: | 1003 WILLOW CREEK RD | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863011641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287781971 | ||||||||
| FaxNumber: | 9827715733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 07/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | DANGELO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9287781971 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.