MEDICARE: MIDWEST IMAGING CENTER, 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	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist

Other Identifiers

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

General Provider Information

NPI Number	:	1295707297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST IMAGING CENTER, LLC

Provider Business Mailing Address
First Line	:	604 MAPLE VALLEY DR
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1976
Country	:	US
Telephone Number	:	573-760-1674
Fax Number	:	573-760-0228

Provider Business Practice Location Address
First Line	:	604 MAPLE VALLEY DR
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1976
Country	:	US
Telephone Number	:	573-760-1674
Fax Number	:	573-760-0228

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JENNIFER M SKINNER
Credential	:
Telephone Number	:	573-756-7779

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	11/02/2011

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Directions to “MIDWEST IMAGING CENTER, LLC ” Practice Location

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