Provider Demographics
NPI:1336101856
Name:OZARK MOBILE IMAGING LLC
Entity Type:Organization
Organization Name:OZARK MOBILE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-232-2727
Mailing Address - Street 1:306 S BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3418
Mailing Address - Country:US
Mailing Address - Phone:816-232-2727
Mailing Address - Fax:816-232-2771
Practice Address - Street 1:2012 CHERRY HILL DR
Practice Address - Street 2:SUITE 202E
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5882
Practice Address - Country:US
Practice Address - Phone:816-232-2727
Practice Address - Fax:816-232-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO716090808OtherMEDICAID
MO000040062OtherMEDICARE AREA 99
KS388930OtherMEDICARE KS STATEWIDE
KS200347870OtherMEDICAID
P00060615OtherRAILROAD MEDICARE