Organization
OZARK MOBILE IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZACHARY B EVANS (MEMBER)
(816) 232-2727
Entity
Organization
Contact information
Practice address
2012 CHERRY HILL DR, SUITE 202E, COLUMBIA, MO 65203-5882
(816) 232-2727
(816) 232-2771
Mailing address
306 S BELT HWY, SAINT JOSEPH, MO 64506-3418
(816) 232-2727
(816) 232-2771
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
—
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000040062
MEDICARE AREA 99
MO
01
—
200347870
MEDICAID
KS
01
—
388930
MEDICARE KS STATEWIDE
KS
01
—
716090808
MEDICAID
MO
01
—
P00060615
RAILROAD MEDICARE
—
Enumeration date
04/03/2006
Last updated
08/31/2011
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