Healthcare Provider Details

I. General information

NPI: 1619848256
Provider Name (Legal Business Name): BEYOND DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 OLIVE ST
SAINT LOUIS MO
63103-1427
US

IV. Provider business mailing address

2815 OLIVE ST
SAINT LOUIS MO
63103-1427
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-2747
  • Fax: 314-818-0006
Mailing address:
  • Phone: 314-361-2747
  • Fax: 314-818-0006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DALLAS HOLLAND
Title or Position: OWNER
Credential:
Phone: 314-585-6887