# PROWAVE DIAGNOSTICS LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** IGH LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1265786305
- **Legal business name:** IGH LLC
- **Authorized official:** STEPHANIE CONGER (BILLING MANAGER)
- **Authorized official phone:** (615) 419-3375

## Contact information

- **Practice address:** 238 PEACH LN, RIDGEDALE, MO 65739-4182
- **Practice address phone:** (831) 477-6633
- **Mailing address:** PO BOX 130, RIDGEDALE, MO 65739-0130

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | — | MO | Yes |

## Other

- **Enumeration date:** 10/27/2012
- **Last updated:** 10/27/2012