1871689505 NPI number — RADIOLOGIC IMAGING CONSULTANTS, LLP

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 1871689505 NPI number — RADIOLOGIC IMAGING CONSULTANTS, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGIC IMAGING CONSULTANTS, LLP
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:
1871689505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 COMPASS POINT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST CHARLES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-947-4480
Provider Business Mailing Address Fax Number:
636-947-9860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 FIRST CAPITOL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST CHARLES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-947-5444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROOT
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
636-947-4480

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: O16294 . This is a "FMH EXCLUSIVE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 06022955 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 117184 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 21317X21317 . This is a "HEALTHCARE USA GROUP NUMB" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 370477200 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 503988503 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 266417 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 438386 . This is a "HEALTHLINK GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4355 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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