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General NPI Number Information
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NPI Number | 1326335019
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Entity Type | Organization
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Legal Business Name | IMAGING PARTNERS OF ST. PETERS, LLC
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 112 PIPER HILL DR SUITE 5
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City | SAINT PETERS
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State | MO
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Zip | 63376-1690
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Country | US
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Telephone | 636-229-4247
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Fax | 636-229-4248
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Provider Business Mailing Address
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Address Line | 112 PIPER HILL DR SUITE 5
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City | SAINT PETERS
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State | MO
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Zip | 63376-1690
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Country | US
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Telephone | 636-229-4247
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Fax | 636-229-4248
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. JIM P KIDD
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Credential |
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Telephone | 636-229-4239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | LC1142668
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License Number State | MO
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