Healthcare Provider Details

I. General information

NPI: 1437476900
Provider Name (Legal Business Name): PEARL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4293 VETERANS MEMORIAL PKWY
SAINT PETERS MO
63376-1657
US

IV. Provider business mailing address

PO BOX 796017
SAINT LOUIS MO
63179-6000
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-1818
  • Fax: 314-567-3359
Mailing address:
  • Phone: 314-567-1818
  • Fax: 314-567-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RITA PAU
Title or Position: MANAGER
Credential:
Phone: 314-567-1818