Organization
MIRAGE IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON FUNK (CEO)
(620) 663-4800
Entity
Organization
Contact information
Practice address
1818 E 23RD AVE, HUTCHINSON, KS 67502-1106
(620) 663-4800
(620) 663-4803
Mailing address
1818 E 23RD AVE, HUTCHINSON, KS 67502-1106
(620) 663-4800
(620) 663-4803
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111244
BCBS PROVIDER NO.
KS
Enumeration date
07/27/2006
Last updated
08/22/2020
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