Provider Demographics
NPI:1932378197
Name:TRI-LAKES DIAGNOSTIC IMAGING, LLC
Entity Type:Organization
Organization Name:TRI-LAKES DIAGNOSTIC IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT,R,M
Authorized Official - Phone:417-739-9110
Mailing Address - Street 1:523 STATE HIGHWAY 248
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7740
Mailing Address - Country:US
Mailing Address - Phone:417-739-9110
Mailing Address - Fax:417-739-5640
Practice Address - Street 1:523 STATE HIGHWAY 248
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7740
Practice Address - Country:US
Practice Address - Phone:417-332-2152
Practice Address - Fax:417-332-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)