Provider Demographics
NPI:1275947756
Name:BELLEVILLE DIAGNOSTIC CENTER, LLC
Entity Type:Organization
Organization Name:BELLEVILLE DIAGNOSTIC CENTER, LLC
Other - Org Name:BELLEVILLE OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-416-7977
Mailing Address - Street 1:7 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5958
Mailing Address - Country:US
Mailing Address - Phone:618-416-7977
Mailing Address - Fax:618-416-7976
Practice Address - Street 1:7 CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5958
Practice Address - Country:US
Practice Address - Phone:618-416-7977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)