Healthcare Provider Details

I. General information

NPI: 1962432492
Provider Name (Legal Business Name): SIGNATURE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date: 04/12/2024
Reactivation Date: 06/13/2024

III. Provider practice location address

12639 OLD TESSON ROAD SUITE 125
SAINT LOUIS MO
63128-2786
US

IV. Provider business mailing address

12639 OLD TESSON RD STE 115
SAINT LOUIS MO
63128-2786
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-0311
  • Fax: 314-849-4423
Mailing address:
  • Phone: 314-849-0311
  • Fax: 314-849-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHAD SACKMAN
Title or Position: CEO
Credential:
Phone: 314-849-0311