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General NPI Number Information
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NPI Number | 1770725962
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Entity Type | Organization
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Legal Business Name | IMAGING ADVANTAGE LLC
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 04/02/2009
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Provider Practice Location Address
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Address Line | 425 W FIFTH ST
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City | EAST LIVERPOOL
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State | OH
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Zip | 43920-2405
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Country | US
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Telephone | 866-708-6580
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Fax | 314-845-5667
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Provider Business Mailing Address
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Address Line | 6245 LEMAY FERRY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63129-2805
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Country | US
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Telephone | 800-354-1088
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Fax | 314-845-5668
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Authorized Official
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Title or Position | COO
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Name | BASSAM CHABALLOUT
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Credential |
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Telephone | 310-721-0200
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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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