1689628869 NPI number — WATSON IMAGING CENTER

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 1689628869 NPI number — WATSON IMAGING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WATSON IMAGING CENTER
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:
1689628869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2151 JANUARY AVE
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:
63110-2935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-645-4900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3915 WATSON RD
Provider Second Line Business Practice Location Address:
STE. LL2
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63109-1251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-781-9711
Provider Business Practice Location Address Fax Number:
314-781-9768
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOODHOPE
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
636-282-0184

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  NA , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 852265 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2053 . This is a "BCBSMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9011 . This is a "HCUSA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 235650 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10843 . This is a "ESSENCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 436640 . This is a "FOCUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8352036 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1027473 . This is a "AMERICAN SPECIALTY NETWOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1610036 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2788 . This is a "GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7363390 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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