Provider Demographics
NPI:1063445096
Name:SCOTT RADIOLOGICAL GROUP INC
Entity Type:Organization
Organization Name:SCOTT RADIOLOGICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:JUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:314-647-2344
Mailing Address - Street 1:2344 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2909
Mailing Address - Country:US
Mailing Address - Phone:314-647-2344
Mailing Address - Fax:314-647-5108
Practice Address - Street 1:1420 HIGHWAY 61 SOUTH
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4108
Practice Address - Country:US
Practice Address - Phone:314-647-2344
Practice Address - Fax:314-647-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27716V27716OtherGROUP HEALTH PLAN
MO194361OtherBLUE CROSS BLUE SHIELD
MOCP4241OtherRAILROAD MEDICARE
MO500875703Medicaid
MO000010084Medicare ID - Type Unspecified