Organization
MID-AMERICA RADIOLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY D CROCKETT DO (DO)
(660) 259-2203
Entity
Organization
Contact information
Practice address
1500 STATE ST, LEXINGTON, MO 64067-1107
(660) 259-2203
(660) 259-6806
Mailing address
1500 STATE ST, LEXINGTON, MO 64067-1107
(660) 259-2203
(660) 259-6806
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507573509
—
MO
01
—
DH1403
RR MEDICARE
MO
Enumeration date
06/06/2006
Last updated
01/31/2014
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