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General NPI Number Information
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NPI Number | 1164622965
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC AND DIAGNOSTIC IMAGING LLC
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 2345 DOUGHERTY FERRY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63122-3313
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Country | US
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Telephone | 314-984-8827
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Fax | 314-985-1001
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Provider Business Mailing Address
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Address Line | 9930 WATSON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63126-1845
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Country | US
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Telephone | 314-984-8827
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Fax | 314-985-1001
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. JOHN G. LANDGRAF
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Credential |
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Telephone | 314-984-8827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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