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NPI Code Detail

MEDICARE: DIAGNOSTIC IMAGING ASSOCIATES LTD

MEDICARE: DIAGNOSTIC IMAGING ASSOCIATES LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033142146
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIAGNOSTIC IMAGING ASSOCIATES LTD
Provider Business Mailing Address
First Line : 13209 CORPORATE EXCHANGE DR
Second Line :
City : BRIDGETON
State : MO
Zip : 63044-3721
Country : US
Telephone Number : 314-471-8323
Fax Number : 314-548-4748
Provider Business Practice Location Address
First Line : 232 S WOODS MILL RD
Second Line :
City : CHESTERFIELD
State : MO
Zip : 63017-3406
Country : US
Telephone Number : 314-434-1500
Fax Number : 314-548-4748
Authorized Official
Title or Position : CREDENTIALING
Name : JEANIE SUMMERS
Credential :
Telephone Number : 314-471-8323
Provider Enumeration Date : 07/09/2006
Last Update Date : 06/09/2020

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