| NPI | 1083045090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM HARPER Credentialing Manager 267-979-8095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging |
| 2085B0100X Radiology, Body Imaging | |
| 2085N0700X Radiology, Neuroradiology | |
| 2085N0904X Radiology, Nuclear Radiology | |
| 2085P0229X Radiology, Pediatric Radiology | |
| 2085R0001X Radiology, Radiation Oncology | |
| 2085R0204X Radiology, Vascular & Interventional Radiology | |
| 2085U0001X Radiology, Diagnostic Ultrasound | |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2022-01-27 |