Provider Demographics
NPI:1811210206
Name:RAYMORE MEDICAL IMAGING INC
Entity Type:Organization
Organization Name:RAYMORE MEDICAL IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALAKISHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-244-8132
Mailing Address - Street 1:244 BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9298
Mailing Address - Country:US
Mailing Address - Phone:816-331-6100
Mailing Address - Fax:816-331-8315
Practice Address - Street 1:244 BROADMOOR DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9298
Practice Address - Country:US
Practice Address - Phone:816-331-6100
Practice Address - Fax:816-331-8315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty