Provider Demographics
NPI:1922034586
Name:ADVANCED MEDICAL IMAGING - TALLGRASS
Entity Type:Organization
Organization Name:ADVANCED MEDICAL IMAGING - TALLGRASS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-502-1209
Mailing Address - Street 1:PO BOX 781838
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67278-1838
Mailing Address - Country:US
Mailing Address - Phone:877-502-1209
Mailing Address - Fax:877-219-2990
Practice Address - Street 1:6001 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1004
Practice Address - Country:US
Practice Address - Phone:785-271-2250
Practice Address - Fax:785-271-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS500000OtherHEALTH PARTNERS OF KANSAS
KS111005OtherBLUE CROSS BLUE SHIELD
KS416240OtherFIRSTGUARD
KSP00158322OtherPALMETTO
KS416240OtherFIRSTGUARD