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General NPI Number Information
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NPI Number | 1629000971
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Entity Type | Organization
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Legal Business Name | ERNST RADIOLOGY CLINIC, INC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 12303 DEPAUL DR DEPAUL HEALTH CENTER
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City | BRIDGETON
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State | MO
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Zip | 63044
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Country | US
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Telephone | 314-344-6350
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Fax |
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Provider Business Mailing Address
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Address Line | 12255 DEPAUL DR STE 737
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City | BRIDGETON
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State | MO
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Zip | 63044-2530
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Country | US
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Telephone | 314-770-9393
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Fax | 314-770-9997
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT GRESICK
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Credential | MD
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Telephone | 314-344-6350
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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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