Provider Demographics
NPI:1225024300
Name:NCK RADIOLOGY PA
Entity Type:Organization
Organization Name:NCK RADIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:KUEKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-243-1188
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901-0325
Mailing Address - Country:US
Mailing Address - Phone:785-243-1188
Mailing Address - Fax:785-243-1151
Practice Address - Street 1:400 W 8TH ST
Practice Address - Street 2:MITCHELL COUNTY HOSPITAL
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420-1605
Practice Address - Country:US
Practice Address - Phone:785-738-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110830Medicare ID - Type Unspecified