Provider Demographics
NPI:1467637769
Name:HUBLALL RADIOLOGY, LLC
Entity Type:Organization
Organization Name:HUBLALL RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:V
Authorized Official - Last Name:HUBLALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-825-0896
Mailing Address - Street 1:PO BOX 25673
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66225-5673
Mailing Address - Country:US
Mailing Address - Phone:913-825-0896
Mailing Address - Fax:913-825-3786
Practice Address - Street 1:1905 W 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1529
Practice Address - Country:US
Practice Address - Phone:417-626-0072
Practice Address - Fax:417-626-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004019512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty