Organization
BREAST IMAGING OF THE OZARKS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOGAN LACKEY II MD (OWNER/MD)
(870) 945-9455
Entity
Organization
Contact information
Practice address
2144 E REPUBLIC RD STE 104, SPRINGFIELD, MO 65804-4623
(870) 945-9455
Mailing address
3206 4TH ST, LONGVIEW, TX 75605-5143
(903) 663-4800
(903) 663-9960
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
01/31/2022
Last updated
01/31/2022
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