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General NPI Number Information
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NPI Number | 1851632566
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Entity Type | Organization
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Legal Business Name | EMERSON ROAD IMAGING CENTER LLC
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 633 EMERSON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6739
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Country | US
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Telephone | 314-991-4674
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Fax |
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Provider Business Mailing Address
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Address Line | 633 EMERSON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6739
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MS. KELLY A WOLTERING
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Credential |
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Telephone | 314-991-4674
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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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