PK Xray, Inc

Primary specialty

Radiologic TechnologistTaxonomy code 247100000X

License

RT1299 Issued in AR

Legal business name

PK XRAY, INC

Practice address

3379A Green Acres Rd
Springdale, AR 72764-0236

Phone

(918) 683-9729

Fax

(918) 683-1012

NPI assigned

Nov 7, 2007

Last updated

Nov 24, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Phillips Lee Kizzia

Title

President

Phone

(918) 683-9729

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227484800000",
    "number": "1477733418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "347 S 37TH ST",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744014906",
            "telephone_number": "918-683-9729",
            "fax_number": "918-683-1012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3379A GREEN ACRES RD",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727640236",
            "telephone_number": "918-683-9729",
            "fax_number": "918-683-1012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PK XRAY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-07",
        "last_updated": "2008-11-24",
        "status": "A",
        "authorized_official_last_name": "KIZZIA",
        "authorized_official_first_name": "PHILLIPS",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-683-9729",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "247100000X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist",
            "state": "AR",
            "license": "RT1299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165224710",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Radiologic Technologist in Springdale, AR
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 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.