Provider Demographics
NPI:1558510586
Name:DIAGNOSTIC RADIOLOGY SERVICES, PROF, LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC RADIOLOGY SERVICES, PROF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-689-1000
Mailing Address - Street 1:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-0572
Mailing Address - Country:US
Mailing Address - Phone:605-689-1000
Mailing Address - Fax:605-689-1001
Practice Address - Street 1:2212 VALLEY RD
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-1895
Practice Address - Country:US
Practice Address - Phone:605-689-1000
Practice Address - Fax:605-689-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD39552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty