Healthcare Provider Details

I. General information

NPI: 1902239338
Provider Name (Legal Business Name): BIOMEDICAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 BRIDGELAND DR SUITE F
BRIDGETON MO
63044-2605
US

IV. Provider business mailing address

3450 BRIDGELAND DR SUITE F
BRIDGETON MO
63044-2605
US

V. Phone/Fax

Practice location:
  • Phone: 314-972-0100
  • Fax:
Mailing address:
  • Phone: 314-972-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number33867
License Number StateMO

VIII. Authorized Official

Name: DR. SHARAD P PARIKH
Title or Position: MANAGER
Credential: MD
Phone: 314-831-4200