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SOUTHTOWNE IMAGING CENTER LLC NPI 1104991918


NPI Information

NPI: 1104991918
Provider Name: SOUTHTOWNE IMAGING CENTER LLC
Classification: Clinic/Center - 261QR0200X
Entity Type: Organization

Specialization: Radiology

Address:
20 SOUTHTOWNE DR
POTOSI, MO
ZIP 63664
Phone: (573) 436-6736
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SOUTHTOWNE IMAGING CENTER LLC is a radiology clinic center in Potosi, MO. SOUTHTOWNE IMAGING CENTER LLC NPI is 1104991918. The provider is registered as an organization entity type.

The provider's business location address is:

20 SOUTHTOWNE DR
POTOSI, MO
ZIP 63664-729
Phone: (573) 436-6736
Fax: (573) 436-7321

The provider's authorized official is Henry Boots .
The authorized official title is Owner/manager and has the following contact phone number (573) 315-9109.

The enumeration date for this NPI number is 11/21/2006 and was last updated on 2/17/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QR0200XClinic/CenterRadiologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
159787OTHERMISSOURIHEALTHCARE USA NUMBER
2P00277531OTHERMISSOURIRAILROAD MEDICARE NUMBER
3269801OTHERMISSOURIGHP NUMBER
4000047057MEDICARE PINMISSOURI
5710002502MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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