| NPI | 1083266761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN MARIE VAUGHN AO 629-317-1465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound |
| 2085B0100X Radiology, Body Imaging | |
| 2085R0204X Radiology, Vascular & Interventional Radiology | |
| 2085N0904X | |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2026-03-25 |