Provider Demographics
NPI:1487659140
Name:MEDICAL IMAGING ASSOCIATES OF MEXICO MO
Entity Type:Organization
Organization Name:MEDICAL IMAGING ASSOCIATES OF MEXICO MO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CYRIAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-582-8553
Mailing Address - Street 1:201 E MONROE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2852
Mailing Address - Country:US
Mailing Address - Phone:800-354-1088
Mailing Address - Fax:314-845-5668
Practice Address - Street 1:620 E MONROE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2919
Practice Address - Country:US
Practice Address - Phone:573-582-5000
Practice Address - Fax:314-845-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO711517003Medicaid
MO1311OtherBCBS MO PIN
MO210116OtherHEALTHLINK PIN
MODE6186OtherMEDICARE RAILROAD
MO000011463Medicare PIN