Provider Demographics
NPI:1508874595
Name:DALCOR INC
Entity Type:Organization
Organization Name:DALCOR INC
Other - Org Name:MIDWEST CANCER SCREENING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:417-889-6644
Mailing Address - Street 1:1936 E SUNSHINE
Mailing Address - Street 2:STE E
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804
Mailing Address - Country:US
Mailing Address - Phone:417-889-6644
Mailing Address - Fax:417-889-9095
Practice Address - Street 1:1936 E SUNSHINE
Practice Address - Street 2:STE E
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-889-6644
Practice Address - Fax:417-889-9095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000420240Medicaid
OH2251209Medicaid
WA7124878Medicaid
NE10025129700Medicaid
NJ8169900Medicaid
NE10025129700Medicaid