Provider Demographics
NPI:1104874510
Name:HAYSVILLE DIAGNOSTIC CENTER LLC
Entity type:Organization
Organization Name:HAYSVILLE DIAGNOSTIC CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:316-491-2093
Mailing Address - Street 1:2020 N. TYLER RD
Mailing Address - Street 2:STE. # 114
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212
Mailing Address - Country:US
Mailing Address - Phone:316-491-2093
Mailing Address - Fax:316-491-2097
Practice Address - Street 1:2020 N TYLER RD
Practice Address - Street 2:STE. # 114
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4916
Practice Address - Country:US
Practice Address - Phone:316-491-2093
Practice Address - Fax:316-491-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1200X
KS236167261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Not Answered261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS130594OtherBCBS KS
KS500179OtherHEALTH PARTNERS OF KS
KS5510599OtherCCN NETWORK
KS=========OtherUNITED HEALTHCARE
KS500179OtherHEALTH PARTNERS OF KS
KS130594OtherBCBS KS
KS=========OtherTRICARE
KS=========OtherWPPA
KS5510599OtherCCN NETWORK
KS=========OtherFIRSTGUARD
KS=========OtherEVOLUTIONS
KS500179OtherHEALTH PARTNERS OF KS