MEDICARE: CT PARTNERS OF CHESTERFIELD, LLC

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	261QR0200X	Radiology Clinic/Center	LC0717282	MO

General Provider Information

NPI Number	:	1164647657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CT PARTNERS OF CHESTERFIELD, LLC

Provider Business Mailing Address
First Line	:	14825 NORTH OUTER FORTY RD.
Second Line	:	STE 110
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-2026
Country	:	US
Telephone Number	:	636-449-3990
Fax Number	:	636-449-3997

Provider Business Practice Location Address
First Line	:	14825 NORTH OUTER FORTY RD.
Second Line	:	STE 110
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-2026
Country	:	US
Telephone Number	:	636-449-3990
Fax Number	:	636-449-3997

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MS. DAWN G STEWART
Credential	:	RT (R)(MR)
Telephone Number	:	636-449-3990

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	04/24/2012

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