MEDICARE: CYBER DIAGNOSTIC MEDICINE 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	NA	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	P00322519	OTHER	MO	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	141322400	OTHER	MO	US DEPT OF LABOR
2	1952654	OTHER	MO	FIRST HEALTH HAMPTON
3	98923	OTHER	MO	GROUP HEALTH PLAN
4	M0754	OTHER	MO	ONE CALL MEDICAL FLORISSA
5	37636	OTHER	MO	HCUSA HAMPTON
6	466492	OTHER	MO	HEALTHLINK
7	2632204	OTHER	MO	AETNA HMO
8	49881	OTHER	MO	HCUSA FLORISSANT
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	0334	OTHER	MO	MERCY CAREPLUS
12	M0753	OTHER	MO	ONE CALL MEDICAL HAMPTON
13	1601446	OTHER	MO	UHC
14	193985	OTHER	MO	BCBS
15	5495635	OTHER	MO	CCN
16	2233063	OTHER	MO	FIRST HEALTH FLORISSANT
17	4446827	OTHER	MO	AETNA
18	A149477	OTHER	MO	MULTIPLAN

General Provider Information

NPI Number	:	1437253754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYBER DIAGNOSTIC MEDICINE LLC

Provider Business Mailing Address
First Line	:	11901 W FLORISSANT AVE
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-6778
Country	:	US
Telephone Number	:	314-839-9901
Fax Number	:

Provider Business Practice Location Address
First Line	:	11901 W FLORISSANT AVE
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-6778
Country	:	US
Telephone Number	:	314-839-9901
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SYED HAIDER
Credential	:
Telephone Number	:	314-839-9901

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	10/23/2007

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Directions to “CYBER DIAGNOSTIC MEDICINE LLC ” Practice Location

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