1689628869 NPI number — WATSON IMAGING CENTER

Table of content: (NPI 1689628869)

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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