Provider Demographics
NPI:1073646246
Name:TRI-LAKES DIAGNOSTIC TECH.
Entity Type:Organization
Organization Name:TRI-LAKES DIAGNOSTIC TECH.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:HINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-332-2152
Mailing Address - Street 1:523 STATE HIGHWAY 248 STE 300
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7748
Mailing Address - Country:US
Mailing Address - Phone:417-332-2152
Mailing Address - Fax:417-332-0443
Practice Address - Street 1:523 ST. HWY 248 STE 300
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7748
Practice Address - Country:US
Practice Address - Phone:417-332-2152
Practice Address - Fax:417-332-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty