Provider Demographics
NPI:1073666236
Name:NATIONAL IMAGING, LTD
Entity Type:Organization
Organization Name:NATIONAL IMAGING, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-729-5517
Mailing Address - Street 1:4713 N PORTWEST CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-2356
Mailing Address - Country:US
Mailing Address - Phone:316-729-5517
Mailing Address - Fax:316-729-5655
Practice Address - Street 1:4713 N PORTWEST CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67204-2356
Practice Address - Country:US
Practice Address - Phone:316-729-5517
Practice Address - Fax:316-729-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-146642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000111205OtherKS BCBS GROUP #
OK200041060AMedicaid
OK200041060AMedicaid
KS111205Medicare ID - Type UnspecifiedKS MEDICARE GROUP #
OK200522042Medicare ID - Type UnspecifiedOK MEDICARE GROUP #