MEDICARE: ALPHA MEDICAL 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1225466691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA MEDICAL IMAGING INC

Provider Business Mailing Address
First Line	:	5650 MEXICO RD
Second Line	:	SUITE 15
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1696
Country	:	US
Telephone Number	:	636-498-2900
Fax Number	:	636-498-2904

Provider Business Practice Location Address
First Line	:	5650 MEXICO RD
Second Line	:	SUITE 15
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1696
Country	:	US
Telephone Number	:	636-498-2900
Fax Number	:	636-498-2904

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. NADER T AZABIN
Credential	:
Telephone Number	:	630-605-0295

Provider Enumeration Date	:	10/23/2013
Last Update Date	:	10/23/2013

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