Breast Imaging of the Ozarks LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

BREAST IMAGING OF THE OZARKS LLC

Practice address

2144 E Republic Rd Ste 104
Springfield, MO 65804-4623

Phone

(870) 945-9455

NPI assigned

Jan 31, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Logan Lackey II, MDNPI 1740506419

Title

Owner/MD

Phone

(870) 945-9455

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Logan B Lackey II, M.D.

  • Diagnostic Radiology Physician
  • Springfield, MO
  • NPI 1740506419
  Medicare reassignment Care Compare group NPD Authorized official
• Amanda Elizabeth Lackey, MD

  • Diagnostic Radiology Physician
  • Saint Louis, MO
  • NPI 1194041855
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643587200000",
    "number": "1417600412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3206 4TH ST",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756055143",
            "telephone_number": "903-663-4800",
            "fax_number": "903-663-9960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2144 E REPUBLIC RD STE 104",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044623",
            "telephone_number": "870-945-9455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAST IMAGING OF THE OZARKS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-31",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A",
        "authorized_official_last_name": "LACKEY",
        "authorized_official_first_name": "LOGAN",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "870-945-9455",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Nicole Bravin, M.D.
• Marlana Marie Bray
• Tyler Bray
• Maria J Brazil, MD
• Breaking the Mental Chains, LLC
• Breath of Life Wellness Center
• James Brecheisen, MD
• Becky Breckner, LPC
• Nicole Bredbenner
• Lori R. Breedlove, MD

• Diagnostic Radiology Physician in Springfield, MO
• Providers in Springfield, MO by specialty
• Diagnostic Radiology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.