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NPI Code Detail

MEDICARE: SOUTH COUNTY IMAGING CENTER LLC

MEDICARE: SOUTH COUNTY 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
12085R0202XDiagnostic Radiology Physician
22085U0001XDiagnostic Ultrasound Physician
32085B0100XBody Imaging Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1313190OTHERMOGHP
273674OTHERMOHCUSA
31078863OTHERUSA MCO

General Provider Information

NPI Number : 1881702728
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH COUNTY IMAGING CENTER LLC
Provider Business Mailing Address
First Line : 12345 W BEND DR
Second Line : STE 200
City : SAINT LOUIS
State : MO
Zip : 63128-2104
Country : US
Telephone Number : 314-843-8000
Fax Number : 314-843-3004
Provider Business Practice Location Address
First Line : 12345 W BEND DR
Second Line : STE 200
City : SAINT LOUIS
State : MO
Zip : 63128-2104
Country : US
Telephone Number : 314-843-8000
Fax Number : 314-843-3004
Authorized Official
Title or Position : OWNER/PRESIDENT
Name : DR. ABRAHAM S HAWATMEH
Credential : MD
Telephone Number : 314-843-8000
Provider Enumeration Date : 08/29/2006
Last Update Date : 04/20/2008

Similar Medicare Providers

1184696627 — DR. SALIM I HAWATMEH M.D.
Practice Location Address:
12345 W BEND DR , SUITE 200
SAINT LOUIS, MO
63128-2104
Practice Phone: 314-843-8000
Practice Fax: 314-843-3004
1003846700 — MR. LESLIE THARON CRANICK P.A.
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1669407516 — DR. IBRAHIM SALIM HAWATMEH M.D.
Practice Location Address:
12345 W BEND DR , SUITE 200
SAINT LOUIS, MO
63128-2104
Practice Phone: 314-843-8000
Practice Fax: 314-843-3004
1114952074 — DR. FREDERICK P WALTERS M.D.
Practice Location Address:
12345 W BEND DR , SUITE200
SAINT LOUIS, MO
63128-2104
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Practice Fax: 314-843-3004
1003824350 — SOUTH COUNTY UROLOGICAL, INC.
Practice Location Address:
12345 W BEND DR , SUITE 200
SAINT LOUIS, MO
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1912026345 — MRS. LINDA DARLENE STEFANO FNP
Practice Location Address:
12345 W BEND DR , SUITE 200
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63128-2104
Practice Phone: 314-843-8000
Practice Fax:

Directions to “SOUTH COUNTY IMAGING CENTER LLC ” Practice Location

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