Provider Demographics
NPI:1205234689
Name:LITTLE BEAR RADIOLOGY, LLC
Entity type:Organization
Organization Name:LITTLE BEAR RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-289-8211
Mailing Address - Street 1:1104 E BROADWAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1104 E BROADWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5121
Practice Address - Country:US
Practice Address - Phone:417-448-3713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty