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General NPI Number Information
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NPI Number | 1346631843
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Entity Type | Organization
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Legal Business Name | MIDWEST IMAGING CENTER II, LLC
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Dates
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Enumeration Date | 02/05/2015
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 20 SOUTHTOWNE DR
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City | POTOSI
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State | MO
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Zip | 63664-5729
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Country | US
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Telephone | 573-436-6736
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Fax |
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Provider Business Mailing Address
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Address Line | 600 MAPLE VALLEY DR
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City | FARMINGTON
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State | MO
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Zip | 63640-1976
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Country | US
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Telephone | 573-760-1674
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Fax |
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Authorized Official
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Title or Position | MM
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Name | MR. HENRY E BOOTS II
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Credential |
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Telephone | 573-315-9109
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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 |
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License Number State |
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