Provider Demographics
NPI:1437253754
Name:CYBER DIAGNOSTIC MEDICINE LLC
Entity Type:Organization
Organization Name:CYBER DIAGNOSTIC MEDICINE LLC
Other - Org Name:HAMPTON AND FLORISSANT OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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:314-839-9901
Mailing Address - Street 1:11901 W FLORISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6778
Mailing Address - Country:US
Mailing Address - Phone:314-839-9901
Mailing Address - Fax:
Practice Address - Street 1:11901 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6778
Practice Address - Country:US
Practice Address - Phone:314-839-9901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MONA261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO141322400OtherUS DEPT OF LABOR
MO1952654OtherFIRST HEALTH HAMPTON
MO98923OtherGROUP HEALTH PLAN
MOM0754OtherONE CALL MEDICAL FLORISSA
MO37636OtherHCUSA HAMPTON
MO466492OtherHEALTHLINK
MO2632204OtherAETNA HMO
MO49881OtherHCUSA FLORISSANT
MO717265102Medicaid
MOP00322519OtherMEDICARE RR
MO0334OtherMERCY CAREPLUS
MOM0753OtherONE CALL MEDICAL HAMPTON
MO1601446OtherUHC
MO193985OtherBCBS
MO5495635OtherCCN
MO2233063OtherFIRST HEALTH FLORISSANT
MO4446827OtherAETNA
MOA149477OtherMULTIPLAN
MO466492OtherHEALTHLINK