Healthcare Provider Details

I. General information

NPI: 1073522801
Provider Name (Legal Business Name): BIG BEND IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S KIRKWOOD RD STE 110
KIRKWOOD MO
63122-7250
US

IV. Provider business mailing address

1001 S KIRKWOOD RD STE 110
KIRKWOOD MO
63122-7250
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-9173
  • Fax: 314-821-6157
Mailing address:
  • Phone: 314-821-9173
  • Fax: 314-821-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY CUNDIFF
Title or Position: MANAGER
Credential:
Phone: 502-664-6280