MEDICARE: J. RONALD ANDERSSEN

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	261QR0208X	Mobile 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	:	1821285479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J. RONALD ANDERSSEN

Provider Business Mailing Address
First Line	:	14824 CLAYTON RD
Second Line	:	SUITE 21
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-7888
Country	:	US
Telephone Number	:	636-227-6878
Fax Number	:	636-227-7822

Provider Business Practice Location Address
First Line	:	14824 CLAYTON RD
Second Line	:	SUITE 21
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-7888
Country	:	US
Telephone Number	:	636-227-6878
Fax Number	:	636-227-7822

Authorized Official
Title or Position	:	OWNER
Name	:	J. RONALD ANDERSSEN
Credential	:	R.T.
Telephone Number	:	636-227-6878

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	12/08/2008

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