Organization
POLK COUNTY RADIOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD REBER MD (OWNER)
(417) 328-6446
Entity
Organization
Contact information
Practice address
1500 N OAKLAND AVE, DEPT. OF RADIOLOGY, BOLIVAR, MO 65613-3011
(417) 326-6000
Mailing address
PO BOX 802758, KANSAS CITY, MO 64180-0001
(314) 645-4900
(314) 645-6548
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110449
BCBS
MO
05
—
503989600
—
MO
Enumeration date
05/03/2006
Last updated
08/14/2008
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