Provider Demographics
NPI:1437108842
Name:BIOTECH X-RAY INC
Entity Type:Organization
Organization Name:BIOTECH X-RAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-227-2700
Mailing Address - Street 1:1065 EXECUTIVE PARKWAY DR STE 220
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6367
Mailing Address - Country:US
Mailing Address - Phone:314-227-2700
Mailing Address - Fax:314-227-2720
Practice Address - Street 1:1065 EXECUTIVE PARKWAY DR STE 220
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6367
Practice Address - Country:US
Practice Address - Phone:314-227-2700
Practice Address - Fax:314-227-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO717690309Medicaid
MO630000682OtherRAILROAD MEDICARE
IA0429654Medicaid
MO717690309Medicaid
IL=========002Medicaid
IL216464Medicare PIN
MO13701Medicare ID - Type UnspecifiedMEDICARE OF MO
MO717690309Medicaid
IA0429654Medicaid