Provider Demographics
NPI:1013289875
Name:SHAY MEDICAL IMAGING, LLC
Entity Type:Organization
Organization Name:SHAY MEDICAL IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-777-6499
Mailing Address - Street 1:1703 NW WOODBURY DR
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-7217
Mailing Address - Country:US
Mailing Address - Phone:816-777-6499
Mailing Address - Fax:816-228-9110
Practice Address - Street 1:1703 NW WOODBURY DR
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-7217
Practice Address - Country:US
Practice Address - Phone:816-777-6499
Practice Address - Fax:816-228-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile