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General NPI Number Information
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NPI Number | 1891034229
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Entity Type | Organization
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Legal Business Name | QMB RADIOLOGY LLC
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 35629 HIGHWAY 72
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City | SALEM
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State | MO
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Zip | 65560-7217
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Country | US
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Telephone | 314-550-3494
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Fax | 636-230-5732
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Provider Business Mailing Address
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Address Line | 104 COUNTRY CREEK CT
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City | BALLWIN
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State | MO
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Zip | 63011-3812
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Country | US
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Telephone | 314-550-3494
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Fax | 636-230-5732
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. QASIM MUSTAFA BAJWA
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Credential | M.D
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Telephone | 314-550-3494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | 102285
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License Number State | MO
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