1033142146 NPI number — DIAGNOSTIC IMAGING ASSOCIATES LTD

Table of content: (NPI 1033142146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033142146 NPI number — DIAGNOSTIC IMAGING ASSOCIATES LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTIC IMAGING ASSOCIATES LTD
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:
1033142146
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13209 CORPORATE EXCHANGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGETON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63044-3721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-471-8323
Provider Business Mailing Address Fax Number:
314-548-4748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
232 S WOODS MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63017-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-434-1500
Provider Business Practice Location Address Fax Number:
314-548-4748
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUMMERS
Authorized Official First Name:
JEANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
314-471-8323

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: 711811208 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com