Provider Demographics
NPI:1437476900
Name:PEARL IMAGING, LLC
Entity Type:Organization
Organization Name:PEARL IMAGING, LLC
Other - Org Name:OPEN MRI OF ST. CHARLES COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-567-1818
Mailing Address - Street 1:PO BOX 796017
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-6000
Mailing Address - Country:US
Mailing Address - Phone:314-567-1818
Mailing Address - Fax:314-567-3359
Practice Address - Street 1:4293 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1657
Practice Address - Country:US
Practice Address - Phone:314-567-1818
Practice Address - Fax:314-567-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA3028Medicare PIN