Healthcare Provider Details

I. General information

NPI: 1013219344
Provider Name (Legal Business Name): PURE IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12345 WEST BEND DRIVE
SAINT LOUIS MO
63128-2104
US

IV. Provider business mailing address

12345 W BEND DR SUITE 105
SAINT LOUIS MO
63128-2182
US

V. Phone/Fax

Practice location:
  • Phone: 314-270-3939
  • Fax:
Mailing address:
  • Phone: 314-270-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SYED INAM HAIDER
Title or Position: OWNER
Credential: MBR
Phone: 314-270-3939