NPIMap

Organization Active NPI

Medical Mile Imaging

  • Diagnostic Radiology Physician
  • Springfield, MO
National Provider Identifier
1407389596
Registry record updated Apr 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
R4804 Issued in MO
Legal business name
MEDICAL MILE IMAGING
Practice address
3905 E Windsmore Dr
Springfield, MO 65802
Phone
(417) 864-8360
NPI assigned
Apr 6, 2017
Organization subpart
Yes
Parent organization
MEDICAL MILE IMAGINGAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 6, 2017

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

Authorized official

Name
Dr. Dan T Sullivan, MD
Title
President
Phone
(417) 864-8360

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X R4804 MO Primary

Addresses

Primary practice location

3905 E Windsmore Dr
Springfield, MO 65802

Mailing address

3905 E Windsmore
Springfield, MO 65802

National Provider Directory

National Provider Directory
Part of
Medical Mile Imaging

NPI Registry JSON

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

{
    "created_epoch": "1491436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491436800000",
    "number": "1407389596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3905 E WINDSMORE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "65802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3905 E WINDSMORE DR",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "65802",
            "telephone_number": "417-864-8360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL MILE IMAGING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL MILE IMAGING",
        "enumeration_date": "2017-04-06",
        "last_updated": "2017-04-06",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "DAN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "417-864-8360",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "R4804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2017; 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.