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General NPI Number Information
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NPI Number | 1467322198
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL IMAGING COLUMBIA, LLC
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 1400 FORUM BLVD STE 1E
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City | COLUMBIA
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State | MO
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Zip | 65203-2094
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Country | US
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Telephone | 999-999-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 OLD DES PERES RD STE 30
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City | SAINT LOUIS
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State | MO
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Zip | 63131-1873
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Country | US
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Telephone | 314-743-2000
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Fax | 314-743-2005
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | NICOLE BROOKS
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Credential |
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Telephone | 314-324-3728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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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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