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General NPI Number Information
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NPI Number | 1881702728
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Entity Type | Organization
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Legal Business Name | SOUTH COUNTY IMAGING CENTER LLC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 12345 W BEND DR STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2104
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Country | US
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Telephone | 314-843-8000
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Fax | 314-843-3004
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Provider Business Mailing Address
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Address Line | 12345 W BEND DR STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2104
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Country | US
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Telephone | 314-843-8000
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Fax | 314-843-3004
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ABRAHAM S HAWATMEH
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Credential | MD
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Telephone | 314-843-8000
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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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Taxonomy #2
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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