Basic Information
| Provider Information | |||||||||
| NPI: | 1669471710 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASCENSION VIA CHRISTI IMAGING MANHATTAN, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1329 | ||||||||
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| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857763322 | ||||||||
| FaxNumber: | 7857761988 | ||||||||
| Practice Location | |||||||||
| Address1: | 1133 COLLEGE AVE | ||||||||
| Address2: | BLDG G SUITE 110 | ||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665022770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857763322 | ||||||||
| FaxNumber: | 7855329036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 03/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | YOST | ||||||||
| AuthorizedOfficialFirstName: | CARLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CNO | ||||||||
| AuthorizedOfficialTelephone: | 9139046907 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0206X | H081003 | KS | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mammography | 261QM1200X | N | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) | 261QM1200X | H081003 | KS | N | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) | 261QR0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QR0200X | H081003 | KS | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
ID Information
| ID | Type | State | Issuer | Description | 100411700B | 05 | KS | MEDICAID |