Provider Demographics
NPI:1336633304
Name:MIDWEST IMAGING SPECIALISTS
Entity Type:Organization
Organization Name:MIDWEST IMAGING SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRITHER
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)(MR)(CT)
Authorized Official - Phone:573-381-0790
Mailing Address - Street 1:14825 NORTH OUTER 40 RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2152
Mailing Address - Country:US
Mailing Address - Phone:636-449-3990
Mailing Address - Fax:
Practice Address - Street 1:201 S MOUNT AUBURN RD STE B
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4912
Practice Address - Country:US
Practice Address - Phone:636-449-3990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology