Provider Demographics
NPI:1285692772
Name:KESTER RADIOLOGY, LLC
Entity type:Organization
Organization Name:KESTER RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIANS
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-877-0624
Mailing Address - Street 1:1335 E INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4262
Mailing Address - Country:US
Mailing Address - Phone:417-877-0624
Mailing Address - Fax:417-877-0697
Practice Address - Street 1:2828 N NATIONAL AVE
Practice Address - Street 2:DEPT. OF RADIOLOGY
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4306
Practice Address - Country:US
Practice Address - Phone:417-837-4240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO187799OtherBLUE CROSS/BLUE SHIELD
16-03069OtherUNITED HEALTHCARE
138117XXOtherPREFERRED CARE
=========001OtherTRICARE
138117XXOtherPREFERRED CARE