Healthcare Provider Details

I. General information

NPI: 1861986176
Provider Name (Legal Business Name): BIOMEDICAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 BRIDGELAND DR STE F
BRIDGETON MO
63044-2605
US

IV. Provider business mailing address

3450 BRIDGELAND DR STE F
BRIDGETON MO
63044-2605
US

V. Phone/Fax

Practice location:
  • Phone: 314-972-0100
  • Fax: 314-735-4162
Mailing address:
  • Phone: 314-972-0100
  • Fax: 314-735-4162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: DAWANNA MICHEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 314-831-4200