Provider Demographics
NPI:1316918501
Name:STATE LINE IMAGING LLC
Entity type:Organization
Organization Name:STATE LINE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAMUELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-444-9000
Mailing Address - Street 1:PO BOX 802779
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-0001
Mailing Address - Country:US
Mailing Address - Phone:913-648-9500
Mailing Address - Fax:913-648-9501
Practice Address - Street 1:8700 STATE LINE RD
Practice Address - Street 2:STE 160
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1569
Practice Address - Country:US
Practice Address - Phone:913-648-9500
Practice Address - Fax:913-648-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Multi-Specialty
Not Answered2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS353246Medicare ID - Type UnspecifiedKANSAS MEDICARE
MO9004192Medicare ID - Type UnspecifiedMISSOURI MEDICARE