PROWAVE DIAGNOSTICS LLC (NPI# 1265786305) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265786305 |
| Entity Type | Organization |
| Organization Name | PROWAVE DIAGNOSTICS LLC |
| Practice Address |
238 Peach Ln Ridgedale MO 65739-4182 |
| Mailing Address |
Po Box 130 Ridgedale MO 65739-0130 |
| Practice Telephone | 8314776633 |
| Enumeration Date | 2012-10-27 |
| Last Update Date | 2012-10-27 |
| Authorized Official Name | STEPHANIE CONGER (BILLING MANAGER) |
| Authorized Official Telephone | 6154193375 |
| Is Organization Subpart | Y |
| Parent Organization Name | IGH LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | MO | Suppliers |
| Street Address |
238 PEACH LN |
| City | RIDGEDALE |
| State | MO |
| Zip Code | 65739-4182 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396944294 | Amanda Wyatt Detar | Emergency Medicine | 3799 Ridgedale Rd, Suite 1, Ridgedale, MO 65739 | 2007-07-12 |
| 1790341303 | Watson's Family Medical Clinic | Family Medicine | 3799 Ridgedale Rd, Ridgedale, MO 65739 | 2019-05-20 |
| 1417315318 | Fanae Watson | Nurse Practitioner | 3799 Ridgedale Rd, Ridgedale, MO 65739 | 2016-02-05 |
| 1720144629 | Nicholas C. Yiannios D.d.s., P.C. | Dentist | 920 State Highway 86, Ridgedale, MO 65739-4312 | 2006-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396944294 | Amanda Wyatt Detar | Emergency Medicine | 3799 Ridgedale Rd, Suite 1, Ridgedale, MO 65739 | 2007-07-12 |
| 1720144629 | Nicholas C. Yiannios D.d.s., P.C. | Dentist | 920 State Highway 86, Ridgedale, MO 65739-4312 | 2006-12-28 |
| 1790341303 | Watson's Family Medical Clinic | Family Medicine | 3799 Ridgedale Rd, Ridgedale, MO 65739 | 2019-05-20 |
| 1417315318 | Fanae Watson | Nurse Practitioner | 3799 Ridgedale Rd, Ridgedale, MO 65739 | 2016-02-05 |
| Taxonomy Code | 335V00000X |
| Grouping | Suppliers |
| Classification | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (Holter Monitor), bone densitometry, sonography, and other imaging services in accordance with all state and federal requirements, under the general supervision of a qualified physician. All necessary resources are transported to the patient's location where the services are performed. |
| Notes: Source: National Uniform Claim Committee, 2015 [1/1/2016: title and definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952946378 | Mjm Diagnostics LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 1301 Oak St Ste 713, Kansas City, MO 64106-2913 | 2019-11-08 |
| 1861986176 | Biomedical Imaging LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 3450 Bridgeland Dr Ste F, Bridgeton, MO 63044-2605 | 2018-06-20 |
| 1508225715 | Missouri Diagnostic Services, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 1517 Copper Rd, Holts Summit, MO 65043-2033 | 2016-02-16 |
| 1891125142 | Midwest Mobile Imaging | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 408 Washington Ave Ste 107, West Plains, MO 65775-3404 | 2013-11-23 |
| 1720239767 | American Mobile X-ray, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 221 Adair Road, Branson, MO 65615-7865 | 2008-10-08 |
| 1528214913 | Innovative Mobile Services LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 202 Miller Way, Monett, MO 65708-8336 | 2008-08-18 |
| 1790959773 | Digital X Mobile, Inc. | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 13 Cedar Crest Dr, Fenton, MO 63026-5041 | 2008-04-21 |
| 1376749812 | Mobile X-ray Services LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 3050 N 20th St, Ozark, MO 65721-5925 | 2007-06-22 |
| 1720106958 | Gateway Sonographics, Inc. | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 1115 James Dr, Imperial, MO 63052-2343 | 2007-03-26 |
| 1417016114 | Hannibal Mobile Diagnostics, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 2910 St. Mary's Ave., Hannibal, MO 63401 | 2006-12-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.