Provider Demographics
NPI:1295790582
Name:LITTON & GIDDINGS RADIOLOGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:LITTON & GIDDINGS RADIOLOGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:417-894-0878
Mailing Address - Street 1:PO BOX 2727
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2727
Mailing Address - Country:US
Mailing Address - Phone:417-889-6102
Mailing Address - Fax:417-874-4071
Practice Address - Street 1:COX HOSPITAL DEPT OF RADIOLOGY
Practice Address - Street 2:3801 SOUTH NATIONAL
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-269-4056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1256OtherBLUE
AR107958002OtherAR MEDICAID
MO710480302Medicaid
MO000010242Medicare PIN
MO1256OtherBLUE
MO710480302Medicaid