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General NPI Number Information
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NPI Number | 1699750695
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Entity Type | Organization
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Legal Business Name | CARDIAC DIAGNOSTIC CENTER LLC
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 08/13/2009
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Provider Practice Location Address
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Address Line | 10004 KENNERLY RD SUITE 281B
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2141
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Country | US
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Telephone | 314-543-5270
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Fax | 314-543-5289
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Provider Business Mailing Address
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Address Line | 10004 KENNERLY RD SUITE 281B
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2141
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Country | US
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Telephone | 314-543-5270
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Fax | 314-543-5289
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CAT LOPEZ
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Credential |
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Telephone | 314-543-5270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207UN0902X
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Taxonomy Name | Nuclear Imaging & Therapy Physician
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License Number | 4560
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License Number State | MO
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