Healthcare Provider Details

I. General information

NPI: 1467638445
Provider Name (Legal Business Name): SOUNDWAVE IMAGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 N NEW BALLAS RD STE 270
CREVE COEUR MO
63141-6819
US

IV. Provider business mailing address

PO BOX 308
MILLSTADT IL
62260-0308
US

V. Phone/Fax

Practice location:
  • Phone: 314-276-7028
  • Fax:
Mailing address:
  • Phone: 314-276-7028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER J ALLEN
Title or Position: PRESIDENT
Credential: RDMS, RVT
Phone: 314-276-7028