Provider Demographics
NPI:1093756926
Name:RADIOLOGIC PROFESSIONAL SERVICES. P.A.
Entity Type:Organization
Organization Name:RADIOLOGIC PROFESSIONAL SERVICES. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-841-3211
Mailing Address - Street 1:1112 W 6TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2215
Mailing Address - Country:US
Mailing Address - Phone:785-841-3211
Mailing Address - Fax:784-841-8570
Practice Address - Street 1:1112 W 6TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2215
Practice Address - Country:US
Practice Address - Phone:785-841-3211
Practice Address - Fax:784-841-8570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10087980AMedicaid
KS10087980AMedicaid