Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | | N/A | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | IL1650 | MEDICARE PIN | ILLINOIS | |
| 2 | ZZZ01973Z | MEDICARE PIN | CALIFORNIA | |
| 3 | P00289013 | OTHER | KANSAS | RAILROAD MEDICARE |
| 4 | 280136 | MEDICAID | ARIZONA | |
| 5 | P00289009 | MEDICARE PIN | MISSOURI | |
| 6 | 000047056 | MEDICARE ID-TYPE UNSPECIFIED | MISSOURI | ST LOUIS AREA |
| 7 | 9004265B | MEDICARE ID-TYPE UNSPECIFIED | MISSOURI | RURAL MO - KC AREA |
| 8 | 710957507 | MEDICAID | MISSOURI | |
| 9 | 710360009 | MEDICAID | MISSOURI | |
| 10 | 200333170A | MEDICAID | KANSAS | |
| 11 | 117531 | MEDICARE PIN | ARIZONA | |
| 12 | 97Z921 | MEDICARE PIN | NEW YORK | |
| 13 | 9004265A | MEDICARE ID-TYPE UNSPECIFIED | MISSOURI | KANSAS CITY MO AREA |
| 14 | 9004265 | MEDICARE ID-TYPE UNSPECIFIED | KANSAS | |