Provider Demographics
NPI:1891762449
Name:MR IMAGING CENTER LLC
Entity Type:Organization
Organization Name:MR IMAGING CENTER LLC
Other - Org Name:ANATOMI IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:ALLFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-946-5080
Mailing Address - Street 1:PO BOX 48123
Mailing Address - Street 2:ATTEN: NATALIE WATSON
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-8123
Mailing Address - Country:US
Mailing Address - Phone:316-946-5080
Mailing Address - Fax:316-946-5088
Practice Address - Street 1:928 N SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3822
Practice Address - Country:US
Practice Address - Phone:316-946-5080
Practice Address - Fax:316-946-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2085B0100X, 2085N0700X, 2085P0229X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100245720AMedicaid
KS004223OtherBCBS
KSKA1306Medicare PIN
KS004223Medicare PIN