Provider Demographics
NPI:1679512701
Name:RADIOLOGY SPECIALISTS OF ST JOSEPH PC
Entity Type:Organization
Organization Name:RADIOLOGY SPECIALISTS OF ST JOSEPH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-271-6575
Mailing Address - Street 1:PO BOX 8252
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64508-8252
Mailing Address - Country:US
Mailing Address - Phone:816-271-6575
Mailing Address - Fax:816-271-7644
Practice Address - Street 1:5325 FARAON ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3488
Practice Address - Country:US
Practice Address - Phone:816-271-6575
Practice Address - Fax:816-271-7644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111294OtherBCBS OF KS FOR KS LOCATIO
KS470766OtherBCBS OF KS FOR MO LOCATIO
MOCK7871OtherRR MEDICARE
MO509395802Medicaid
KSDG5299OtherRR MEDICARE
KS200400950AMedicaid
MO32212011OtherBCBS KC MO
KS470766OtherBCBS OF KS FOR MO LOCATIO
MON480000Medicare ID - Type UnspecifiedMEDICARE NUMBER
KS200400950AMedicaid