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General NPI Number Information
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NPI Number | 1184710824
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Entity Type | Organization
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Legal Business Name | XRT IV, INC.
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 2 WILLIAMS DR
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City | UNION
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State | MO
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Zip | 63084-2919
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Country | US
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Telephone | 636-583-9161
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Fax | 636-583-1919
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Provider Business Mailing Address
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Address Line | 2 WILLIAMS DR
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City | UNION
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State | MO
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Zip | 63084-2919
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Country | US
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Telephone | 636-583-9161
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Fax | 636-583-1919
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. SALVATORE CONTI
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Credential | M D
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Telephone | 636-583-9161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R5635
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R5409
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License Number State | MO
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