1760578496 NPI number — METRO IMAGING, LLC

Table of content: (NPI 1760578496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760578496 NPI number — METRO IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO IMAGING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760578496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11615 OLIVE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-7274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-993-9555
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11615 OLIVE BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CREVE COEUR
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-993-9555
Provider Business Practice Location Address Fax Number:
314-993-9550
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
314-333-6725

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 326978 . This is a "HEALTHLINK GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 613714 . This is a "HEALTHLINK GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0006015396 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 184965 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 434256 . This is a "HEALTHLINK GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 12261X12261 . This is a "HEALTHCARE USA GROUP NUMB" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 27190 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 251201 . This is a "HEALTHLINK GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 375706 . This is a "HEALTHLINK GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 8351085 . This is a "AETNA GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 140091100 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1601369 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000000010625 . This is a "ESSENCE HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 266417 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 711435800 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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