Healthcare Provider Details

I. General information

NPI: 1710971080
Provider Name (Legal Business Name): SPECIALIZED IMAGING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9785 MACKENZIE RD SUITE 101
SAINT LOUIS MO
63123-5438
US

IV. Provider business mailing address

9785 MACKENZIE RD SUITE 101
SAINT LOUIS MO
63123-5438
US

V. Phone/Fax

Practice location:
  • Phone: 314-544-3536
  • Fax:
Mailing address:
  • Phone: 314-544-3536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER TURNER
Title or Position: CEO
Credential:
Phone: 214-242-8500