Healthcare Provider Details

I. General information

NPI: 1003353152
Provider Name (Legal Business Name): E-CLOUD RADIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7304 STREAM VALLEY CT
SAINT LOUIS MO
63129-5291
US

IV. Provider business mailing address

PO BOX 270625
SAINT LOUIS MO
63127-0625
US

V. Phone/Fax

Practice location:
  • Phone: 314-740-4018
  • Fax:
Mailing address:
  • Phone: 314-740-4018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS R FRENZ
Title or Position: MANAGING MEMBER
Credential:
Phone: 314-740-4018