Organization
MAGNETIC RESONANCE SERVICES PTR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY JOHN LUCAS M.D. (PRESIDENT)
(641) 424-0102
Entity
Organization
Contact information
Practice address
1010 4TH ST SW, SUITE 100, MASON CITY, IA 50401-2857
(641) 424-0102
(641) 424-8059
Mailing address
1420 6TH ST SW, MASON CITY, IA 50401-4818
(641) 424-0102
(641) 424-8059
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0288787
—
IA
01
—
34523
WELLMARK BCBS OF IA
IA
Enumeration date
05/17/2006
Last updated
12/29/2011
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