Organization
PRAIRIE CREEK IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN SHURTZ MD (PRESIDENT)
(316) 262-1103
Entity
Organization
Contact information
Practice address
500 S MAIN ST, WICHITA, KS 67202-3722
(316) 262-1103
Mailing address
PO BOX 2854, WICHITA, KS 67201-2854
(316) 685-3698
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110957
BCBS
KS
01
—
DA5653
RAILROAD MEDICARE
—
Enumeration date
03/09/2006
Last updated
09/11/2025
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