Provider Demographics
NPI:1396411559
Name:PROFESSIONAL IMAGING KANSAS CITY
Entity Type:Organization
Organization Name:PROFESSIONAL IMAGING KANSAS CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-324-3728
Mailing Address - Street 1:777 S NEW BALLAS RD LBBY 5
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8721
Mailing Address - Country:US
Mailing Address - Phone:314-324-3728
Mailing Address - Fax:
Practice Address - Street 1:1 E ARMOUR BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1201
Practice Address - Country:US
Practice Address - Phone:999-999-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2085B0100XOtherRADIOLOGY- BODY IMAGING
MO2085R0202XOtherRADIOLOGY- DIAGNOSTIC RADIOLOGY