MEDICARE: MISSOURI IMAGING, INC

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
1	2085R0202X	Diagnostic Radiology Physician		MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	470000936	OTHER		MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7495351	OTHER		AETNA
2	610049401	OTHER		DOL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	199688	OTHER	MO	BC

General Provider Information

NPI Number	:	1104884881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOURI IMAGING, INC

Provider Business Mailing Address
First Line	:	PO BOX 934995
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-4995
Country	:	US
Telephone Number	:	866-659-1211
Fax Number	:	336-774-1751

Provider Business Practice Location Address
First Line	:	5905 MEXICO RD
Second Line	:
City	:	ST PETERS
State	:	MO
Zip	:	63376-1613
Country	:	US
Telephone Number	:	636-498-2900
Fax Number	:	636-498-2904

Authorized Official
Title or Position	:	COO
Name	:	MR. DANIEL J SCHAEFER
Credential	:
Telephone Number	:	770-300-0101

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	12/01/2009

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Directions to “MISSOURI IMAGING, INC ” Practice Location

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