Basic Information
| Provider Information | |||||||||
| NPI: | 1295004257 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KYLE CROSSING IMAGING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14149 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708984149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259249827 | ||||||||
| FaxNumber: | 2259249829 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 BUNTON CREEK ROAD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | KYLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259249827 | ||||||||
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| ProviderEnumerationDate: | 12/21/2011 | ||||||||
| LastUpdateDate: | 12/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | STAGG | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2259529141 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
No ID Information.