NPIMap

Organization Active NPI

Kennett Radiology Associates

  • Diagnostic Radiology Physician
  • Kennett, MO
National Provider Identifier
1083878284
Registry record updated Jul 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
R2G95 Issued in MO
Legal business name
KENNETT RADIOLOGY ASSOCIATES
Practice address
1301 1St St
Kennett, MO 63857-2525
Phone
(573) 888-8424
Fax
(573) 888-2715
NPI assigned
Jul 16, 2008
Organization subpart
Yes
Parent organization
KENNETT HMA PHYSICIAN MANAGEMENT, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Michelle Beacham
Title
Controller
Phone
(573) 888-8424

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X R2G95 MO Primary

Addresses

Primary practice location

1301 1St St
Kennett, MO 63857-2525

Mailing address

1231 1St St
Suite 8
Kennett, MO 63857-2527
Phone (573) 888-8424

Other identifiers 1

IdentifierTypeStateIssuer
500451901MedicaidMO

National Provider Directory

National Provider Directory
Tax ID family
Kennett Hma Phys MGMT LLC3 organizations share this tax ID, including this one
Part of
Kennett Hma Phys MGMT LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1083878284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1231 1ST ST",
            "address_2": "SUITE 8",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638572527",
            "telephone_number": "573-888-8424",
            "fax_number": "573-888-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 1ST ST",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638572525",
            "telephone_number": "573-888-8424",
            "fax_number": "573-888-2715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETT RADIOLOGY ASSOCIATES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENNETT HMA PHYSICIAN MANAGEMENT, INC.",
        "enumeration_date": "2008-07-16",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "BEACHAM",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "573-888-8424",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "R2G95",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500451901",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennett, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.