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General NPI Number Information
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NPI Number | 1720232192
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Entity Type | Organization
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Legal Business Name | ELITE IMAGING OF NORTH COUNTY, LLC
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 12/16/2008
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Provider Practice Location Address
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Address Line | 433 LYNN HAVEN LN
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City | HAZELWOOD
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State | MO
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Zip | 63042-1808
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Country | US
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Telephone | 314-731-0600
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Fax | 314-731-0601
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Provider Business Mailing Address
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Address Line | 433 LYNN HAVEN LN
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City | HAZELWOOD
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State | MO
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Zip | 63042-1808
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Country | US
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Telephone | 314-731-0600
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Fax | 314-731-0601
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Authorized Official
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Title or Position | MEMBER
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Name | CECIL S. GRAY
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Credential |
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Telephone | 913-669-6161
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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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