Healthcare Provider Details

I. General information

NPI: 1871689505
Provider Name (Legal Business Name): RADIOLOGIC IMAGING CONSULTANTS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FIRST CAPITOL DRIVE
ST CHARLES MO
63301
US

IV. Provider business mailing address

220 COMPASS POINT DR
ST CHARLES MO
63301
US

V. Phone/Fax

Practice location:
  • Phone: 636-947-5444
  • Fax:
Mailing address:
  • Phone: 636-947-4480
  • Fax: 636-947-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN ROOT
Title or Position: PARTNER
Credential: M.D.
Phone: 636-947-4480