MEDICARE: SPECIALIZED IMAGING SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	293D00000X	Physiological Laboratory
2	261QR0208X	Mobile Radiology Clinic/Center
3	261QR0200X	Radiology Clinic/Center

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	:	1710971080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALIZED IMAGING SERVICES, INC.

Provider Business Mailing Address
First Line	:	9785 MACKENZIE RD
Second Line	:	SUITE 101
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-5438
Country	:	US
Telephone Number	:	314-544-3536
Fax Number	:

Provider Business Practice Location Address
First Line	:	9785 MACKENZIE RD
Second Line	:	SUITE 101
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-5438
Country	:	US
Telephone Number	:	314-544-3536
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHRISTOPHER TURNER
Credential	:
Telephone Number	:	214-242-8500

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/28/2009

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Directions to “SPECIALIZED IMAGING SERVICES, INC. ” Practice Location

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