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NPI Code Detail

MEDICARE: LAKES REGION IMAGING LLC

MEDICARE: LAKES REGION IMAGING 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
12085R0202XDiagnostic Radiology PhysicianMO

Other Identifiers

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

General Provider Information

NPI Number : 1548265697
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKES REGION IMAGING LLC
Provider Business Mailing Address
First Line : 152 LEMAY FERRY RD
Second Line : STE 201
City : SAINT LOUIS
State : MO
Zip : 63125-1254
Country : US
Telephone Number : 800-354-1088
Fax Number : 314-631-4491
Provider Business Practice Location Address
First Line : 251 SKAGGS RD
Second Line :
City : BRANSON
State : MO
Zip : 65616-2031
Country : US
Telephone Number : 417-335-7000
Fax Number : 314-631-4491
Authorized Official
Title or Position : PRESIDENT/PROVIDER
Name : DR. SCOTT L ROSSOW
Credential : MD
Telephone Number : 417-335-7000
Provider Enumeration Date : 06/16/2005
Last Update Date : 07/21/2022

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Directions to “LAKES REGION IMAGING LLC ” Practice Location

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