Provider Demographics
NPI:1437209160
Name:DIAGNOSTIC IMAGING SERVICES, LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGENNARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-853-8667
Mailing Address - Street 1:2020 N WOODLAWN ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1852
Mailing Address - Country:US
Mailing Address - Phone:316-687-1674
Mailing Address - Fax:316-687-5788
Practice Address - Street 1:2020 N WOODLAWN ST
Practice Address - Street 2:SUITE 350
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-1852
Practice Address - Country:US
Practice Address - Phone:316-687-1674
Practice Address - Fax:316-687-5788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100409770AMedicaid
KS110677Medicare ID - Type Unspecified