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General NPI Number Information
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NPI Number | 1821013418
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Entity Type | Organization
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Legal Business Name | MIDWEST RADIOLOGICAL ASSOCIATES PC
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 04/20/2020
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Provider Practice Location Address
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Address Line | 3015 N BALLAS ROAD MISSOURI BAPTIST MEDICAL CENTER
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City | ST LOUIS
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State | MO
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Zip | 63131
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Country | US
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Telephone | 314-548-4715
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Fax | 314-821-2180
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Provider Business Mailing Address
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Address Line | 13209 CORPORATE EXCHANGE DR
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City | BRIDGETON
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State | MO
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Zip | 63044-3721
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Country | US
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Telephone | 314-548-4715
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Fax | 866-302-5278
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER THORNTON
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Credential | MD
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Telephone | 314-548-4715
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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 | 12444
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License Number State | MO
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