NPIMap

Organization Active NPI

High Desert Radiology, P.C.

Doing business as High Desert Vein Center

  • Diagnostic Radiology Physician
  • Kingman, AZ
National Provider Identifier
1255601613
Registry record updated Mar 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
42974 Issued in AZ
Legal business name
HIGH DESERT RADIOLOGY, P.C.
Doing business as
High Desert Vein Center
Practice address
3439 Southern Vista Dr
Kingman, AZ 86401-0630
Phone
(928) 718-0180
Fax
(928) 718-0181
NPI assigned
Jan 3, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2012

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

Authorized official

Name
Kale D Bodily, M.D.
Title
President
Phone
(928) 757-0620

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X 42974 AZ Primary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X 42974 AZ

Addresses

Primary practice location

3439 Southern Vista Dr
Kingman, AZ 86401-0630

Mailing address

P.O. Box 4148
Kingman, AZ 86402-4148
Phone (928) 718-0180

Other identifiers 2

IdentifierTypeStateIssuer
1562979-4OtherAZCORPORATION FILE NUMBER
674865MedicaidAZ

Other names 1

  • High Desert Vein Center Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1325548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330646400000",
    "number": "1255601613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 4148",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864024148",
            "telephone_number": "928-718-0180",
            "fax_number": "928-718-0181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3439 SOUTHERN VISTA DR",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864010630",
            "telephone_number": "928-718-0180",
            "fax_number": "928-718-0181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGH DESERT RADIOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-03",
        "last_updated": "2012-03-02",
        "status": "A",
        "authorized_official_last_name": "BODILY",
        "authorized_official_first_name": "KALE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-757-0620",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "42974",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "AZ",
            "license": "42974",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATION FILE NUMBER",
            "identifier": "1562979-4",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "674865",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "High Desert Vein Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingman, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; 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.