Provider Demographics
NPI:1417092958
Name:CENTRAL PLAINS RADIOLOGY
Entity Type:Organization
Organization Name:CENTRAL PLAINS RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-542-3400
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67025-0190
Mailing Address - Country:US
Mailing Address - Phone:316-542-3400
Mailing Address - Fax:
Practice Address - Street 1:126 N MAIN
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:KS
Practice Address - Zip Code:67025-0190
Practice Address - Country:US
Practice Address - Phone:316-542-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103953111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660046OtherBCBS
KSU37365Medicare UPIN
KS660046OtherBCBS