Provider Demographics
NPI:1386678076
Name:DIGITAL RADIOLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:DIGITAL RADIOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-832-1442
Mailing Address - Street 1:PO BOX 1179
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-1179
Mailing Address - Country:US
Mailing Address - Phone:316-832-1442
Mailing Address - Fax:316-219-2990
Practice Address - Street 1:2021 N AMIDON AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2100
Practice Address - Country:US
Practice Address - Phone:316-832-1442
Practice Address - Fax:316-219-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110948OtherBLUE CROSS BLUE SHIELD
KS200251060AMedicaid
KS110948OtherBLUE CROSS BLUE SHIELD
KS=========OtherPREFERRED HEALTH SYSTEMS