1144235961 NPI number — CENTRAL RADIOLOGY GROUP LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144235961 NPI number — CENTRAL RADIOLOGY GROUP LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL RADIOLOGY GROUP 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:
1144235961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 796000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-260-4144
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 N NEW BALLAS RD STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-6817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-567-4449
Provider Business Practice Location Address Fax Number:
952-541-5443
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GEORGE
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-567-4449

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: 1609093 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 686 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CE7457 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6668 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 710440009 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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