Provider Demographics
NPI:1346631843
Name:MIDWEST IMAGING CENTER II, LLC
Entity Type:Organization
Organization Name:MIDWEST IMAGING CENTER II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MM
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOOTS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:573-315-9109
Mailing Address - Street 1:600 MAPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1976
Mailing Address - Country:US
Mailing Address - Phone:573-760-1674
Mailing Address - Fax:
Practice Address - Street 1:20 SOUTHTOWNE DR
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-5729
Practice Address - Country:US
Practice Address - Phone:573-436-6736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology