Provider Demographics
NPI:1770458192
Name:KINGDOM DIAGNOSTICS LLC
Entity type:Organization
Organization Name:KINGDOM DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAYON
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:RVT, RDCS, RMDS, RT
Authorized Official - Phone:806-773-1877
Mailing Address - Street 1:1403 11TH PL
Mailing Address - Street 2:
Mailing Address - City:SHALLOWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79363-5138
Mailing Address - Country:US
Mailing Address - Phone:806-705-7084
Mailing Address - Fax:806-810-5868
Practice Address - Street 1:2022 82ND ST UNIT 101
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-4317
Practice Address - Country:US
Practice Address - Phone:806-705-7084
Practice Address - Fax:806-810-5868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty