| Organization Name: | TRI-LAKES DIAGNOSTIC TECH. |
| NPI Number: | 1073646246 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID P HINTZ (PRESIDENT) |
| Mailing Address: | 523 St. Hwy 248 Ste 300 Branson |
| State: | MO US |
| Postal Code: | 656167748 |
| Phone Number: | 4173322152 |
| Fax Number: | 4173320443 |
| NPI Enumeration Date: | 03/14/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471M1202X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Magnetic Resonance Imaging |
| Taxonomy Definition: | |