Healthcare Provider Details

I. General information

NPI: 1881702728
Provider Name (Legal Business Name): SOUTH COUNTY IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12345 W BEND DR STE 200
SAINT LOUIS MO
63128-2104
US

IV. Provider business mailing address

12345 W BEND DR STE 200
SAINT LOUIS MO
63128-2104
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-8000
  • Fax: 314-843-3004
Mailing address:
  • Phone: 314-843-8000
  • Fax: 314-843-3004

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
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ABRAHAM S HAWATMEH
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 314-843-8000