Provider Demographics
NPI:1629230826
Name:LIONHEART HOLDINGS, LLC
Entity Type:Organization
Organization Name:LIONHEART HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:SUKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-337-4802
Mailing Address - Street 1:2331 S BUSINESS HIGHWAY 65
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672-5105
Mailing Address - Country:US
Mailing Address - Phone:417-337-4802
Mailing Address - Fax:417-339-9133
Practice Address - Street 1:2331 S BUSINESS HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672-5105
Practice Address - Country:US
Practice Address - Phone:417-337-4802
Practice Address - Fax:417-339-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-28
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier