Provider Demographics
NPI:1679550784
Name:ZUBRES RADIOLOGY INC
Entity Type:Organization
Organization Name:ZUBRES RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUBRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-222-7441
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63902-0459
Mailing Address - Country:US
Mailing Address - Phone:573-222-7441
Mailing Address - Fax:573-222-7479
Practice Address - Street 1:221 PHYSICIANS PARK
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3956
Practice Address - Country:US
Practice Address - Phone:573-727-9080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000015665OtherMEDICARE ID
1198060OtherFIRST HEALTH
MO242912434Medicaid
MODN3307OtherRAILROAD MEDICARE
MOP00254931OtherRAILROAD MEDICARE
MO1191801OtherBCBS OF MO
AR159670003Medicaid
211107OtherHEALTHLINK INC