Organization
LINE DIAGNOSTICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYLE F ZEPICK MD (DOCTOR)
(316) 491-5926
Entity
Organization
Contact information
Practice address
630 S HILLSIDE ST, WICHITA, KS 67211-2157
(316) 491-5926
(316) 491-5962
Mailing address
PO BOX 47259, WICHITA, KS 67201
(316) 491-5926
(316) 491-5962
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100414870A
—
KS
01
—
110727
BLUE CROSS BLUE SHIELD OF KANSAS
KS
01
—
CJ7951
RAILROAD MEDICARE
KS
Enumeration date
04/14/2006
Last updated
08/27/2010
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