Organization
LAKE REGIONAL IMAGING PARTNERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID W. HALSELL (SR. V.P., CFO/AUTHORIZED OFFICIAL)
(573) 348-8388
Entity
Organization
Contact information
Practice address
1075 NICHOLS RD, OSAGE BEACH, MO 65065-3093
(573) 348-6161
(573) 348-6162
Mailing address
1075 NICHOLS RD, OSAGE BEACH, MO 65065-3093
(573) 348-6161
(573) 348-6162
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
710698002
—
MO
Enumeration date
05/19/2006
Last updated
08/19/2015
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