Provider Demographics
NPI:1023236171
Name:IMAGING FOR WOMEN LLC
Entity type:Organization
Organization Name:IMAGING FOR WOMEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-268-3305
Mailing Address - Street 1:630 NW ENGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-3973
Mailing Address - Country:US
Mailing Address - Phone:816-453-2700
Mailing Address - Fax:816-453-9943
Practice Address - Street 1:630 NW ENGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-3973
Practice Address - Country:US
Practice Address - Phone:816-453-2700
Practice Address - Fax:816-453-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO367172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
217588OtherMAMM CERTIFICATION#
MO206910119Medicaid
MO24320015OtherKCBCBS GROUP ID#
MO24320015OtherKCBCBS GROUP ID#
MO206910119Medicaid