Provider Demographics
NPI:1144235961
Name:CENTRAL RADIOLOGY GROUP LTD
Entity Type:Organization
Organization Name:CENTRAL RADIOLOGY GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-567-4449
Mailing Address - Street 1:PO BOX 796000
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63199
Mailing Address - Country:US
Mailing Address - Phone:606-260-4144
Mailing Address - Fax:
Practice Address - Street 1:450 N NEW BALLAS RD STE 250
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6817
Practice Address - Country:US
Practice Address - Phone:314-567-4449
Practice Address - Fax:952-541-5443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609093OtherUHC
686OtherBCBS
CE7457OtherRAILROAD MEDICARE
6668OtherGHP
MO710440009Medicaid
MO10487Medicare ID - Type Unspecified