Provider Demographics
NPI:1295801926
Name:KESSINGER DIAGNOSTIC CENTRE
Entity type:Organization
Organization Name:KESSINGER DIAGNOSTIC CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-341-8292
Mailing Address - Street 1:411 US HWY 72 E
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401
Mailing Address - Country:US
Mailing Address - Phone:573-341-8292
Mailing Address - Fax:573-341-8494
Practice Address - Street 1:411 US HWY 72 E
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401
Practice Address - Country:US
Practice Address - Phone:573-341-8292
Practice Address - Fax:573-341-8494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
MO111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty