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Organization

HIGH DESERT RADIOLOGY, P.C.

Active
Other names
High Desert Vein Center
Organization subpart
No

Provider details

NPI number
Authorized official
KALE D BODILY M.D. (PRESIDENT)
(928) 757-0620
Entity
Organization

Contact information

Practice address
3439 SOUTHERN VISTA DR, KINGMAN, AZ 86401-0630
(928) 718-0180
(928) 718-0181
Mailing address
P.O. BOX 4148, KINGMAN, AZ 86402-4148
(928) 718-0180
(928) 718-0181

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
42974
AZ
2085R0204X
Vascular & Interventional Radiology Physician
42974
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1562979-4
CORPORATION FILE NUMBER
AZ
05
674865
AZ
Enumeration date
01/03/2012
Last updated
03/02/2012
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