MEDICARE: AMERICAN HEALTH IMAGING MW, 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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number	:	1982334926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HEALTH IMAGING MW, LLC

Provider Business Mailing Address
First Line	:	10126 WOODFIELD LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2923
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10126 WOODFIELD LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2923
Country	:	US
Telephone Number	:	954-919-5005
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRIS MARTIN
Credential	:
Telephone Number	:	954-919-5005

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/13/2022

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