Healthcare Provider Details

I. General information

NPI: 1790921088
Provider Name (Legal Business Name): BIOTECH X-RAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 EXECUTIVE PARKWAY DR STE 220
SAINT LOUIS MO
63141-6367
US

IV. Provider business mailing address

1065 EXECUTIVE PARKWAY DR STE 220
SAINT LOUIS MO
63141-6367
US

V. Phone/Fax

Practice location:
  • Phone: 314-548-2900
  • Fax: 314-548-2920
Mailing address:
  • Phone: 314-548-2900
  • Fax: 314-548-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number216464
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number000047082
License Number StateMO

VIII. Authorized Official

Name: MRS. TAMARA BISHOP SCHWARTZ
Title or Position: PRESIDENT
Credential:
Phone: 314-449-1669